Characteristics of the pathological images of coronary artery thrombi according to the infarct-related coronary artery in acute myocardial infarction
Characteristics of the pathological images of coronary artery thrombi according to the infarct-related coronary artery in acute myocardial infarction
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DOI：
10.1253/circj.68.308
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发表时间：
2004-04-01
影响因子：
3.3
通讯作者：
Ishikawa, T
中科院分区：
文献类型：
--
作者：
Nagata, Y;Usuda, K;Ishikawa, T
背景不稳定斑块和冠状动脉血栓有时会导致介入治疗后无复流现象，从而有足够的再灌注。右冠状动脉对大血栓的敏感性增加，使成功再灌注更加困难，因此根据梗死相关冠状动脉研究冠状动脉血栓的病理图像特征。方法与结果77例急性心肌梗死（AMI）患者经冠状动脉取栓导管取栓。36例患者血栓中含有动脉粥样硬化细胞。在所有病例中均观察到血小板、纤维蛋白和中性粒细胞。血栓结构成分的平均比率为血小板成分的51.0+/-29.5%（mean +/- SD）、红细胞成分的19.9+/-25.7%和11.9+/-22.5%的动脉粥样硬化成分。30例右冠状动脉血栓中14例可见富红细胞血栓或以红细胞为主的混合血栓，35例左前降支血栓中6例可见富红细胞血栓，11例左回旋支血栓中2例可见富红细胞血栓，1例大隐静脉旁路移植物血栓中可见富红细胞血栓。右冠状动脉血栓中红细胞成分（28.7 ± 30.1%）明显多于左冠状动脉血栓（12.1 ± 18.4%）。结论急性心肌梗死患者冠状动脉血栓主要由血小板组成。在一些患者的血栓中发现了动脉粥样硬化细胞。右冠状动脉中富含红细胞的血栓比左冠状动脉中的血栓多得多。
Background Unstable plaque and coronary arterial thrombi sometimes induce a no-reflow phenomenon after intervention whereby there is sufficient reperfusion. The greater susceptibility of the right coronary artery to development of large thrombi makes successful reperfusion more difficult, therefore the characteristics of the pathological images of coronary arterial thrombi according to the infarct-related coronary artery were investigated. Methods and Results Coronary arterial thrombi were extracted from 77 patients with acute myocardial infarction (AMI) using a thrombectomy catheter. The 36 patients had a thrombus containing atherosclerotic cells. Platelets, fibrin, and neutrophils were seen in all cases. The mean ratios of structural components of thrombi were 51.0+/-29.5% (mean +/- SD) of the platelet component, 19.9+/-25.7% of the erythrocyte component and 11.9+/-22.5% of atherosclerosis component. Erythrocyte-rich thrombi and mixed thrombi mainly composed of erythrocytes were seen in 14 of the 30 cases involving the right coronary artery, 6 of the 35 cases in the left anterior descending artery, 2 of the 11 cases of the left circumflex artery, and in the I case of saphenous vein bypass graft. There was significantly more erythrocyte component in the thrombi from the right coronary artery (28.7+/-30.1%) than in those from the left coronary artery (12.1+/-18.4%). Conclusion Coronary artery thrombi in AMI are composed principally of platelets. Atherosclerotic cells were identified within thrombi from some patients. In the right coronary artery there were many more thrombi that were rich in erythrocytes than in thrombi from the left coronary artery.