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目的采用光学相干层析成像(OCT)观察薄帽纤维粥样斑块(TCFA)在非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者靶血管中的自然分布。方法采用OCT对斑块脂质含量进行半定量评价(角度或象限),测量靶血管开口至纤维帽最薄处距离。结果选择2013年6月至2015年3月住院治疗的连续NSTE-ACS患者33例,其中不稳定型心绞痛24例,非ST段抬高型心肌梗死9例。OCT共检出74处病变;45处靶病变;其中TCFA病变38处(51.4%),非TCFA病变36处(48.6%)。前降支18处TCFA主要集中在近段,其中近段30 mm内13处(72.2%),40 mm内16处(88.9%);回旋支9处TCFA平均分布于整个靶血管,近段距开口30 mm内仅有3个(33.3%);右冠状动脉11处TCFA也平均分布在各段,近段距开口30 mm内仅有4个(36.4%)。结论 NSTE-ACS患者靶血管中TCFA病变更趋于分布在前降支近段,在回旋支和右冠状动脉中则趋于平均分布。
Objective To observe the natural distribution of cap-cap-like atheroma plaque (TCFA) in target vessel of patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) by optical coherence tomography (OCT) Methods The plaque lipid content was semi-quantitatively evaluated (angle or quadrant) using OCT and the distance from the target vessel opening to the thinnest cap was measured. Results Thirty-three consecutive NSTE-ACS patients admitted to hospital from June 2013 to March 2015 were enrolled, including 24 patients with unstable angina pectoris and 9 patients with non-ST-segment elevation myocardial infarction. There were 74 lesions detected in OCT and 45 targeted lesions. Among them, 38 were TCFA lesions (51.4%) and 36 (48.6%) were non-TCFA lesions. The TCFA of the anterior descending artery 18 mainly concentrated in the proximal segment, of which 13 (72.2%) in 30 mm and 16 (88.9%) in 40 mm in the proximal segment. TCFA of 9 gyrus branches distributed evenly throughout the target vessel, There were only 3 (33.3%) within 30 mm of the opening. The TCFA of the right coronary artery 11 was equally distributed in each segment, and only 4 (36.4%) of the proximal segment within 30 mm of the opening. Conclusion TCFA lesions in target vessels of NSTE-ACS patients tend to be located in the proximal segment of anterior descending artery, and tend to be evenly distributed in the circumflex artery and right coronary artery.