Coronary angioscopy in patients with unstable angina pectoris.
Coronary angioscopy in patients with unstable angina pectoris.
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不稳定型心绞痛患者的冠状动脉血管镜检查。
DOI：
10.1056/nejm198610093151501
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发表时间：
1986
期刊：
影响因子：
--
通讯作者：
Morgenstern,L
中科院分区：
文献类型：
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作者：
Sherman,CT;Litvack,F;Grundfest,W;Lee,M;Hickey,A;Chaux,A;Kass,R;Blanche,C;Matloff,J;Morgenstern,L
为了观察不同临床表现的冠心病患者的冠状动脉内病变，我们在10例不稳定型心绞痛患者和10例稳定型冠心病患者的冠状动脉旁路手术期间进行了冠状动脉血管镜检查。我们共检查了32条血管，使用柔性纤维血管镜。22条血管无急性内膜病变; 3条有复杂斑块，6条有血栓，1条两者兼有。冠状动脉造影正确识别了22条血管中没有复杂斑块和血栓，但仅检测到4个复杂斑块中的1个和7个血栓中的1个。在血管镜检查中，稳定型冠心病患者的17条动脉中没有一条有复杂斑块或血栓。在不稳定型心绞痛患者的“违规”动脉中，所有3例加速型心绞痛患者均出现复杂斑块，所有7例静息型心绞痛患者均出现血栓。我们得出结论，血管镜检查经常显示冠状动脉造影未发现的复杂斑块或血栓。我们的观察结果表明，心绞痛综合征是难治性药物治疗可能是由不稳定的病理过程中内膜。斑块的溃疡可能增加劳力型心绞痛的频率和严重程度，随后发生的部分闭塞性血栓可能导致不稳定的静息型心绞痛。（N Engl J Med 1986; 315：913 - 9.）
To visualize intracoronary lesions in patients with different clinical expressions of coronary disease, we performed coronary angioscopy during coronary-artery bypass surgery in 10 patients with unstable angina and 10 patients with stable coronary disease. We examined a total of 32 vessels, using flexible fiberoptic angioscopes. Twenty-two vessels had no acute intimal lesion; three had complex plaques, six had thrombi, and one had both. Coronary angiography correctly identified the absence of complex plaque and thrombus in 22 vessels, but it detected only one of four complex plaques and one of seven thrombi. On angioscopy, none of the 17 arteries in the patients with stable coronary disease had either a complex plaque or thrombus. In the "offending" arteries of the patients with unstable angina, all three patients with accelerated angina had complex plaques and all seven with angina at rest had thrombi.We conclude that angioscopy frequently reveals complex plaques or thrombi not detected by coronary angiography. Our observations suggest that anginal syndromes that are refractory to medical treatment can be caused by unstable pathologic processes in the intima. Ulceration of plaques may increase the frequency and severity of effort angina, and the subsequent development of partially occlusive thrombi may cause unstable rest angina. (N Engl J Med 1986; 315:913–9.)