atherosclerotic plaque detection via ivus 应用 ivus 检测动脉粥样硬化斑块 fudan...
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Atherosclerotic Plaque Detection via IVUS
应用 IVUS 检测动脉粥样硬化斑块
Fudan University, Zhongshan HospitalShanghai Institute of CVD
CIT 2010
Juying Qian, MD, FACC
Limitation of Coronary angiogram
Focal lesion
Diffuse lesion
D%silhouette
50%
50%
• Lower accuracy of quantitative assessment • Little information of the plaque
characteristics
angiogramPositive
remodeling
Coronary angiogram & IVUS
Volcano
intravascular ultrasound
BSC
mechanical Phased array
Normal coronary artery
The relationship between IVUS three layer and the biological intima, media and adventitia
Intima is dense and will appear as a “white” layer between the media and the blood speckles.
Adventitia is composed of collagen that highly reflected by ultrasound (appears white)
Media is made of homogeneous smooth muscle cells and is not reflected by ultrasound (appears dark)
Normal coronary artery
IVUS three layer does not equal to the biological intima, media and adventitia
Abdomial aortic dissection
IVUS classcification of atherosclerosis
Type I or IIInitial lesion or fatty streak
Stage I or II
IVUS classcification of atherosclerosis
Type IIIPre-atheroma
Stage III
IVUS classcification of atherosclerosis
Type IVatheromaStage IV
IVUS classcification of atherosclerosis
Type Vafibro-atheromaStage V
Type Vb
IVUS classcification of atherosclerosis
fibro-atheromaStage V
Type Vc
IVUS classcification of atherosclerosis
fibro-atheromaStage V
IVUS classcification of atherosclerosis
Type VIa:Plaque rupture or erosion
complicated lesions
Stage VI
IVUS classcification of atherosclerosis
Type VIb:hematoma
complicated lesionsStage VI
IVUS classcification of atherosclerosis
Type VIc:thrombuscomplicated lesions
Stage VI
IVUS classcification of atherosclerosis
Qualitative assessment
Eccentric (>0.5)Concentric(<0.5) Eccentric index=0.45
Eccentric index=
(atheroma thickness)max
(atheroma thickness)max-(atheroma thickness)min
Eccentric index=0.67
atheroma eccentricity
Qualitative assessmentAtheroma morphology
Soft plaque Fibrous plaque Calcified plaque
Qualitative assessment
Thrombus
Atheroma morphology
Qualitative assessmentUnstable lesion
plaque rupture and ulceration
Contrast media
Characteristics of vulnerable plaue in IVUS :Area of echolucent zone>1mm2 ;Echolucent area/plaque area >20 %;Thickness of fibrous cap <0.7mm 。
Ge et al, Heart, 1999
Vulnerable plaque
Qualitative assessment
pseudoaneurysm
Myocardial bridging: half-moon echolucent zone
Systolic diastolic
Qualitative assessment
Quantitative measurementBorder indentification
EEM
Edge of intima
Quantitative measurement
Lumen-csa=3.8mm2
Max Lumen D=2.4mm
Min lumen D=2.1mm
lumen
Lumen area stenosis(%) =reference lumen-csa - lumen-csa
reference lumen-csa
Quantitative measurement
EEM-csa=14.2mm2
Lumen-csa=3.8mm2
EEM measurement
Atheroma (plaque+media) area =(14.2-3.8)mm2=10.4mm2
Plaque burden=10.4/14.2=73.2%
Quantitative measurementCalcium measurement
95° 150° 240°
Realtime 3D IVUS imaging
29
Calculation of plaque volume by IVUS
ProximalFiduciary Site
Distal Fiduciary Site
Proximal FiduciarySite
DistalFiduciary Site
Images Courtesy of Cleveland Clinic Intravascular Ultrasound Core Laboratory
Virtual Histology-IVUS
31
2.7%*
-0.4%†
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
2.5
3.0
REVERSAL : primary endpoint –change of total plaque volume
* 与基线相比进展 (P=0.001).†与基线相比无变化 (P=0.98).Nissen SE et al. JAMA. 2004;291:1071-1080.
P=0.02
总斑块体积变化百分比
普伐他汀 40 mg 阿托伐他汀 80 mg
% 变化百分比
ESTABLISH Trial: atorvastatin 20mg
baseline
6m FU
Okazaki S, et al. Circulation. 2004; 110: 1061-68
6m FU
baselineControl atorvastatin
33
-50
-40
-30
-20
-10
0
ESTABLISH :change of plaque volume by
IVUS
*P<0.0001Okazaki S et al. Circulation. 2004:110:1061-1068.
-41.7*
-0.7
-15
-10
-5
0
5
108.7
-13.1*-10.0
-5.0
0.0
5.0
绝
对变
化 (
mm
3)
4.2
-8.3
阿托伐他汀 20 mg 常规治疗
(%) LDL 自基线变化百分比 斑块体积绝对变化(%) 斑块体积变化百分比
变化
百分
比 (
%)
变化
百分
比 (
%)
34
9.6
1.2
0
2
4
6
8
10
12
常规治疗 阿托伐他汀20-80mg
GAIN :斑块体积的变化
P=0.19
治疗 1 年后斑块体积的绝对变化 (mm3)
Schartl M et al. Circulation. 2001;104:387-392.
斑块体积的变
化(mm3)
35
-0.3-2.1
42.2
2.5
11.8
-10
0
10
20
30
40
50
斑块体积 高回声团块( 纤维斑块 )
低回声团块( 富含脂质的斑块 )
治疗
1年
后的
平均
变化
(%
)
*10.1
阿托伐他汀 20-80 mg 常规治疗
高回声团块是斑块更稳定的标志 . 更多的高回声团块代表斑块更稳定
GAIN :斑块内容物的变化
*P=0.021Schartl M et al. Circulation. 2001;104:387-392.
治疗 1 年后斑块内容物变化百分比 (%)
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