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要旨
患者は58歳,男性で,主訴は労作時の胸部圧迫感であった.冠動脈造影では左冠動脈主幹部に偏心性の75%の狭窄病変が認められた.Volcano Therapeutics’ Virtual HistologyTM IVUS(VH IVUS)を用いた検査では,血管断面積は21.1mm2,プラーク面積は15.8mm2であった.プラークの性状は線維組織が66%,線維性脂肪組織が11%,脂肪壊死組織が20%,石灰化組織が2%であった.シンバスタチン20mg/日による内服治療が開始され,T-CHOは256mg/dlから165mg/dl,LDL-Cは178mg/dlから88mg/dlに改善した.3カ月後にステントによる治療が行われたが,冠動脈造影での病変部の狭窄度には変化は認められなかった.VH IVUSでは血管断面積は21.5mm2,プラーク面積は16.4mm2で,プラーク量には変化は認められなかった.組織性状では,線維組織は56%,線維性脂肪組織は42%,脂肪壊死組織は2%,石灰化組織は0%で,脂肪壊死組織の割合は20%から2%に減少し,線維性脂肪組織の割合が約11%から約42%に増加した.シンバスタチンによりプラークの組織性状が安定化したと考えられた.しかし,プラーク量の減少は認められなかったため薬剤溶出性ステントを用いて病変部の治療を行った.VH IVUSはスタチン投与後のプラーク組織性状の評価に有用であることが示唆された.
A 58-year-old man was admitted to our hospital for evaluation of chest oppression on effort. Coronary angiography revealed eccentric 75% stenosis in the left main coronary trunk segment. Volcano Therapeutics’ Virtual HistologyTM intravascular ultrasound(VH IVUS) showed that the cross-sectional vessel area was 21.1mm2, plaque area was 15.8mm2, fibrous tissue was 66%, fibro-fatty tissue was 11%, necrotic core tissue was 20% and dense calcium tissue was 2%. Lipid lowering therapy was continued with the aim of plaque stabilization using simvastatin 20 mg/day. Three months later,VH IVUS was re-performed and showed that the cross-sectional vessel area was 21.5mm2, plaque area was 16.4mm2, fibrous tissue was 56%, fibro-fatty tissue was 42%, necrotic core tissue was 2%. The plaque volume had not decreased, but the percentage of necrotic core tissue in the plaque was reduced from 20 to 2, and the percentage of fibro-fatty tissue had increased from 11 to 42. These changes suggested stabilization of the plaque composition. VH IVUS might be useful in assessment of plaque composition after lipid lowering therapy.
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