Distal embolization during primary angioplasty: Histopathologic features and predictability
Distal embolization during primary angioplasty: Histopathologic features and predictability
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DOI：
10.1016/j.ahj.2005.01.016
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发表时间：
2005-07-01
影响因子：
4.8
通讯作者：
De Caterina, R
中科院分区：
文献类型：
--
作者：
Limbruno, U;De Carlo, M;De Caterina, R
背景：直接经皮冠状动脉介入治疗(PCLS)中的远端栓塞术可能会影响心肌再灌注。我们评估了急诊经皮冠状动脉介入治疗中栓塞率和特点及其与临床和血管造影变量的关系。方法连续46例急性心肌梗死患者接受了带滤器远端保护装置的急诊经皮冠状动脉介入治疗。对回收的血栓碎片进行组织病理学分析，评估纤维蛋白、坏死、脂滴、胶原、粘多糖和白细胞的存在和相对数量，以及总碎片体积。结果46例患者中41例(89%)栓塞物恢复正常，平均碎屑体积为1.2+/-2.2 mm(3)组织学类型以机化血栓为主(47%)。新鲜血栓(29%)、斑块碎片(24%)。在多变量分析中，所考虑的基线临床变量均未对总碎屑体积有显著预测作用。在冠状动脉造影变量中，血栓负荷高的血管造影征象(截断冠状动脉闭塞或冠状动脉内大的负影)在多变量分析中独立预测总碎片体积(优势比15.8，P.20)，或其定性成分。主要由斑块碎片和部分有组织的血栓组成，这些可能对抗血小板药物几乎不起作用。基线血管造影术、血栓负荷高的征象是预测远端栓塞术程度的唯一重要指标。
Background Distal embolization during primary percutaneous coronary interventions (PCls), may affect myocardial reperfusion. We evaluated the prevalence and features of embolization during primary PCI and its relationship with clinical and angiographic variables.Methods Forty-six consecutive patients with acute myocardial infarction underwent primary PCI with a filter-based distal protection device. Histopathologic analysis was performed on retrieved embolic fragments, assessing the presence and relative amount of fibrin, necrosis, lipid droplets, collagen, mucopolysaccharides, and leukocytes, as well as the total debris volume. Such variables were related to baseline clinical and angiographic variables.Results Embolic material was recovered in 41 (89%) of 46 cases, with a mean total debris volume of 1.2 +/- 2.2 mm(3) Prevalent histopathologic patterns were organized thrombus (47%),. fresh thrombus (29%), and plaque fragments (24%). At multivariate analysis, none of the baseline clinical variables considered significantly predicted the total debris volume. Among angiographic variables, angiographic signs of high thrombus burden (cut-off coronary occlusion pattern or large intracoronary minus image) independently predicted the total debris volume at multivariate analysis, (odds ratio 15.8, P.20), or its qualitative composition.Conclusions Distal embolization occurs inmost patients during primary PCI. and mainly consists of plaque fragments and partially organized thrombi, which are likely to be scarcely responsive to antiplatelet drugs. Baseline angiographic, signs of a high thrombus burden are the only significant predictors of the extent of distal embolization.