Pathologic Disparities Between Peripheral Artery Disease and Coronary Artery Disease
Pathologic Disparities Between Peripheral Artery Disease and Coronary Artery Disease
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DOI：
10.1161/atvbaha.119.312864
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发表时间：
2020-09-01
影响因子：
8.7
通讯作者：
Narula, Navneet
中科院分区：
文献类型：
--
作者：
Narula, Nupoor;Olin, Jeffrey W.;Narula, Navneet
动脉粥样硬化是一种涉及多个血管床的全身性疾病。然而，不同血管区域的病理特征和临床表现各不相同。急性冠状动脉综合征是冠状动脉粥样硬化疾病的相对常见的表现，其中血栓形成继发于粥样斑块的纤维帽的破坏(65％-75％)和侵蚀(25％-35％)。与斑块破裂相关的斑块具有大的坏死核心和薄且发炎的纤维帽。然而，无论动脉粥样硬化的程度如何，外周动脉疾病的病理表现都是由血栓形成引起的。大约 75% 显着狭窄的外周动脉存在血栓，其中三分之二的血栓与不明显的动脉粥样硬化有关。在没有冠状动脉样病变的情况下，严重肢体缺血患者的外周动脉中存在闭塞性血栓，提示存在局部血栓形成或远端栓塞的疾病基础。通常观察到内侧血管层的广泛钙化。在这篇综述中，我们描述并比较了急性冠脉综合征和严重肢体缺血患者冠状动脉和外周动脉疾病的病理基础。预计发病机制特征将有助于确定外周动脉疾病高级管理的战略目标。
Atherosclerosis is a systemic disease that involves multiple vascular beds. The pathological characteristics and clinical presentation, however, vary among the different vascular territories. Acute coronary syndrome is a relatively common manifestation of coronary atherosclerotic disease, wherein the thrombosis occurs secondary to disruption (65%-75%) and erosion (25%-35%) of the fibrous caps of atheromatous plaques. The plaques associated with plaque rupture have large necrotic cores and thin and inflamed fibrous caps. However, the pathological manifestations of peripheral artery disease result from thrombosis regardless of the extent of atherosclerosis. Approximately 75% of peripheral arteries with significant stenosis demonstrate presence of thrombi, of which two-thirds have thrombi associated with insignificant atherosclerosis. The presence of obliterative thrombi in peripheral arteries of patients with critical limb ischemia in the absence of coronary artery-like lesions suggests a locally thrombogenic or remotely embolic basis of disease. Extensive calcification of the medial vascular layer is commonly observed. In this review, we have described and compared the pathological basis of coronary and peripheral artery disease in patients with acute coronary syndrome and critical limb ischemia. It is expected that pathogenetic characterization would allow for definition of strategic targets for superior management of peripheral artery disease.