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血管重构之正性重构

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经冠脉CTA,冠脉磁共振(coronary magnetic resonance imaging, coronary MRI), OCT或IVUS等腔内影像,NIRS联合IVUS,可从不同角度观测到贯穿于心脏的各条蜿蜒曲折,宽窄不一的血管成像。若血管外弹力膜(extravascular elastic membrane, EEM)面积介于病变部位近端和远端EEM面积之间,则表示无血管重构。血管重构包括正性重构(positive remodeling)和负性重构(negative remodeling, 若面积大于病变部位近端和远端EEM的面积,称为血管正性重构,反之当EEM面积小于病变部位近端和远端EEM面积,称为血管负性重构,参数上可通过重构指数,即病变部位EEM面积与近远端EEM面积平均值的比(Remodeling Index,RI)来表示,RI>1.0 表示正性重构, RI<1.0 表示负性重构。


IVUS获得的有关血管正性重构的发生率、疾病表现及血管正性重构与临床预后间的关系的相关文献按发表时间排列如下,

  • 1. 2014年原创研究 -“Positive remodeling at 3 year follow up is associated with plaque-free coronary wall segment at baseline: a serial IVUS study 

  • 2. 2014年临床研究 - “Impact of Positive and Negative Lesion Site Remodeling on Clinical Outcomes : Insights From PROSPECT”

  • 3. 2014年随访数据分析 -“Serial intravascular ultrasound assessment of very late stent thrombosis after sirolimus-eluting stent placement

  • 4. 2015年亚组分析 - Comparison of plaque characteristics in narrowings with ST-elevation myocardial infarction (STEMI), non-STEMI/unstable angina pectoris and stable coronary artery disease (from the ADAPT-DES IVUS Substudy)

  • 5. 2017年原创研究 - Relation between baseline plaque features and subsequent coronary artery  remodeling determined by optical coherence tomography and intravascular ultrasound

  • 6. 2018年原创研究 -“ Coronary plaque redistribution after stent implantation is determined by lipid composition: A NIRS-IVUS analysis”

  • 7. 2018年原创研究 -Intravascular Ultrasound and Angioscopy Assessment of Coronary Plaque Components in Chronic Totally Occluded Lesions 

  • 8. 2019年原创研究 - Novel predictors of late lumen enlargement in distal reference segments after successful recanalization of coronary chronic total occlusion