冠状动脉痉挛的血管造影和血管内超声特征  

Characteristic findings by coronary angiography and intravascular ultrasound in spastic coronary arteries

作　　者：向定成[1] 洪长江[1] 龚志华[1] 何建新[1] 马骏[1] 邱建[1] 

机构地区：[1]广州军区广州总医院心内科,510010

出　　处：《中华超声影像学杂志》2005年第1期5-8,共4页Chinese Journal of Ultrasonography

基　　金：广东省自然科学基金课题(032186)

摘　　要：目的探讨冠状动脉痉挛影像学表现的病理学基础。方法选择临床上具有静息性胸痛或胸闷但冠状动脉造影无显著狭窄的患者进行乙酰胆碱试验,对成功诱发了冠状动脉痉挛的患者进行血管内超声检查,研究其血管造影及血管内超声的特征。结果共有42例患者成功地诱发了冠状动脉痉挛,根据影像学特点可以分为节段性及弥漫性冠状动脉痉挛两种类型,冠状动脉造影除两者均为轻、中度狭窄外,前者表现为节段性血管边缘不光滑且常合并肌桥,后者则表现为弥漫性血管僵硬、突然变细及血管边缘粗糙,常见血管迂曲及血流速度缓慢。血管内超声下前者内膜增生较重而范围相对较局限,多形成偏心性纤维斑块,而弥漫性痉挛者多为病变血管以远的全程血管呈均匀的向心性纤维性增生。结论冠状动脉痉挛多发生于轻、中度血管狭窄的基础之上,病变常为稳定的纤维性增生。Objective To investigate pathological changes of spastic coronary artery. Methods The patients with chest pain at rest and without significant coronary artery stenosis in coronary angiogaphy undergone acetylcholine test. Intravascular ultrasound was used to scan the spastic vessels if coronary artery spasm was successfully provoked by acetylcholine test. The images of angiogram and intravascular ultrasound were carefully investigated to find the common characteristics of spastic coronary artery. Results^Coronary artery spasm was successfully provoked in forty-two patients, which can be grouped into segmental spasm and diffuse spasm according to the length and distribution of spastic vessels. Except for slight or moderate coronary artery stenosis by angiography, segmental roughness and usually coronary artery muscular bridge were showed in segmental spasm group, but in diffuse spasm group, stiff vessels, sudden attenuation, rough edge, tortuosity and slow flow were present. Intravascular ultrasound showed local eccentric hyperechoic fibrous plaque in segmental spasm group and diffuse concentric hyperechoic fibrous proliferation along the vessel in diffuse spasm group. No calcification and lipid pool were noticeable in both groups. Conclusions Coronary spasm is usually based on slight and moderate stenosis,whose lesion often manifests stable fibrous proliferation.

关 键 词：冠状动脉痉挛 血管内超声 血管造影 患者 弥漫性 中度 狭窄 增生 斑块 乙酰胆碱 

分 类 号：R445[医药卫生—影像医学与核医学]