| With living standard improvement and life style changing, the incidence of arteriosclerosis has been increased markedly within Chinese population. It has been reported that age-related arteriosclerosis appeared among the population aged over 30 years old;among over 40 years old, arteriosclerosis became a systemic vessel disease. Arteriosclerosis presents mostly as plague arteriosclerosis in extracranial arteries, such as common carotid artery (CCA) and internal carotid artery (ICA), artery middle-level calcification in limb artery and arteriolosclerosis in arterioles of each organ and skull. Due to its superficial position and straight course, CCA can be readily examined using two-dimensional color Doppler ultrasound (2D-CDUS) with accurate results. Hence, CCA has become a research hotspot of medical ultrasound. Based on their studies, some western researchers believed that intimal-medial thickness (IMT) of CCA and its growth rate could be used as an index for the judgment of coronary artery disease (CAD) incidence and pathological changes. Studies from both abroad and domestic researchers on extracranial arteriosclerosis have been reported extensively. As the starting section of lower limb aorta, femoral artery (FA) also has the advantages of superficialposition and straight running and can easily be detected with 2D-CDUS. However, it was not studied as extensively as extracranial artery. Furthermore, few reports covered simulteneous ultrasonic examination of CCA and FA and related these ultrasound results to the incidence of Coronary Artery Disease, aiming to analyzing relationship between pathological alternations of heart and arteriosclerosis of CCA and FA.Purpose: Patients with arteriostenosis ^50% confirmed by coronary artery contrast were examined by 2D-CDUS to acquire diameters(D) and IMT of CCA and FA, hemodynamics-related physical characteristics and environment parameters. Results were compared with the normal controls. The relationship between pathological changes of plague sclerosis of CCA and FA and coronary artery disease was studied and the clinic significance of 2D-CDUS in evaluating arteriosclerotic pathological changes was discussed.Methods: Group Information: Subjects were divided into Coronary Artery Disease Group and Normal Control Group. A total of 90 patients, 56 male and 34 female were in Coronary Artery Disease Group, aged from 42-86 (63±10.6). According to the coronary artery contrasting, these patients were further divided into three subgroups, i.e. arteriostenosis between 50%-70% was Group I(n=24,15 male, 9 female), 71%-90% Group II (n=45,28 male,17 female) and >90% Group III (n=21,13 male, 8 female). There was no significant difference (P>0.05) in respect of the risk factors of incidence among three groups such as age, sex, hypertension, hyperlipemia, diabetes,myocardial infarction, family disease history. There were 50 patients in Normal Control Group, 25 male and 25 female, aged from 50-82 (60.8±7.6). These controls were hospitalized for other reasons, excluding the family positive disease history of hypertension, diabetes, hyperlipemia, smoking history, chronic renal failure, the pathological changes of the patient and his family on angiocardiopathy. Ultrasound Examining Methods: A Philips SONOS HP 5500 with ultra-wideband variable probe was used, with frequency ranging from 3.0 ~11.0MHz and switches set to Frequency Fusion 3 and 100% inosculation. Clearly display the CCA. Measure the vessel diameter(D) 1.0—1.5 cm from the crotch of CCA. Then use M type to display and measure systolic and diastolic vessel diameter (Ds, Dd). After this, place the Pulse Doppler Sampling Volume at the central part of vessel cavity (avoiding spot) to display the blood flowing frequency spectrum, recording the maximum systolic flowing velocity (Vs) and the diastolic ending term minimum flowing velocity (Vd), averaged blood flowing velocity (Vm), pulsatility index (PI) and resistance index (RI). The measurements of IMT were taken at three consecutive points with intervals of 0.5 cm and averaged IMT values were calculated. Set IMT<0.08 cm as normal, 0.08 cm=IMT< 0.12 cm as internal membrane thickening when its surface shows localized prominence inward the vessel cavity and IMT^0.15 cm as the formation of atherosclerolic plague. Pay attention to the plague's location, size and shape, acoustic characteristics, vessel obstruction and stenosis, and hemodynamicschanges. Measure the diameters and thickness of atherosclerotic plague, as well as humeral artery systolic pressure (Ps) and diastolic blood pressure (Pd). Related formula can be used to calculate part of physical characteristics of CCA and environment parameters of hemodynamics, such as arteriosclerosis index 6, artery dilatability (DI), vessel wall switching rate (Ss, Sm), vessel wall peripheral tensile force(Ts, Tm) and vessel wall peripheral dilation rate (ST). On examining femoral artery(FA), put the examining probe slightly inside inward groin ligament to display FA;take the location 1.0 cm from the upper part of crotch of femoral superficial and profunda femoral artery as the measuring point to measure vessel cavity diameter and mean IMT. Likewise, pay attention to the plague inside FA. The scoring method of plague is below. No plague detected was scored 0 point;only one plague is detected on both sides of artery with its thickness less than 30% of vessel diameter, causing no stenosis, scored 1 point;one plague is detected on both sides with its thickness equivalent to 30 - 50% of vessel diameter, or more than one plague exist and less than 30% of vessel diameter, both causing evidenced stenosis, scored 2 points;one plague is detected on both sides with its thickness bigger than 50% of vessel diameter, or more than one plague are detected, one of which has a diameter line equivalent to 30 - 50% of vessel diameter, and causing stenosis, scored 3 points. Examining data was analyzed with SPSS statistic software.Results: There are no significant differences of the diameter of CCA andFA between Coronary Artery Disease Group and Normal Control Group. But significant differences in IMT of CCA and FA were exist between Normal Control Group and Coronary Artery Disease Group I- III(P<0.01). In the three groups of coronary artery disease, IMT was increased with the degree of arteriostenosis, and significant difference was existed between three groups (P<0.05). Plague: In the Control Artery Group, the prevalence rate of CCA plague is 6.0% (3/50), scored 5;in the three groups of coronary artery disease, the prevalence rate were 54.0% (13/24), 76.0% (34/45), 80.9% (17/21), and scored 24, 81, 60 points, respectively. Significant differences are found in prevalence rate and score between Coronary Artery Disease Group and Normal Control Group (P<0.01). FA prevalence rate in control group is 6% (3/50), scored 3 points;for the three groups of coronary artery disease, the FA prevalence rate were 79.2% (19/24) ,84.4% (38/45) ,85.7% (18/21) and scored 38, 114, 62,respectively. From these results, we can realize that there were also significant differences in prevalence rate and score between Coronary Artery Disease Group and Normal Control Group (P<0.01). Hemodynamics: there were significant differences in Vs, Vd and Vm of CCA and FA between Normal Control Group and Coronary Artery Disease Group I-III (P<0.01). Among the Coronary Artery Disease Group, Vs, Vd and Vm were found declining along with the increase of arteriostenosis, and there were significant differences between three groups (P<0.05);no differences between CCA and FA groups (P>0.05). There were significant differences inphysical characteristics and hemodynamic parameters of common carotid artery (6, DI, Ss, Sm, Ts, Tm, ST) between Normal Control Group and Coronary Artery Disease Group I - III (P< 0.01). Among the Coronary Artery Disease Group, 6, Ts, Tm would increase along with the increase of arteriostenosis, significant differences were found between them (P<0.05);whereas DI, Ss, Sm, ST would decline, and significant differences were also found between three groups (P<0.05).Conclusion: There was an evidenced increase of IMT between CCA and FA in Coronary Artery Disease Group (P<0.01). Plague prevalence cases, prevalence rate and plague score increased along with the degree of arteriostenosis, and homodynamic parameters declined;physical characteristics and its hemodynamic environmental parameters also showed some changes with the increase of arteriostenosis. The artery IMT, prevalence rate and score from ultrasonic examination can be used as an objective index for the prediction of outer peripheral arteriosclerosis and coronary artery disease incidence. |
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