Pathology of the vulnerable plaque
Pathology of the vulnerable plaque
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DOI：
10.1016/j.jacc.2005.10.065
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发表时间：
2006-04-18
影响因子：
24
通讯作者：
Kolodgie, FD
中科院分区：
文献类型：
--
作者：
Virmani, R;Burke, AP;Kolodgie, FD
大多数急性冠状动脉综合征（ACS）患者表现为不稳定型心绞痛、急性心肌梗死和冠状动脉猝死。冠状动脉血栓形成最常见的原因是斑块破裂，其次是斑块侵蚀，而钙化结节是罕见的。如果发生冠状动脉疾病的进展，重要的是要认识到ACS的前驱病变。在三种类型的冠状动脉血栓形成中，急性破裂的前驱病变已被假定。与急性斑块破裂最相似的非血栓性病变是薄帽纤维粥样硬化（TCFA），其特征是坏死核心，其上覆盖的纤维帽< 65 μ m，含有罕见的平滑肌细胞，但有大量的巨噬细胞。薄帽纤维粥样硬化最常见于急性心肌梗死死亡患者，最不常见于斑块糜烂。最常见于近端冠状动脉，其次是中段和远端主要冠状动脉。显示TCFA的血管通常不显示严重狭窄，但显示正性重塑。在TCFA中，坏死核心长度约为2至17 mm（平均8 mm），超过75%的病例的基础横截面积狭窄< 75%（直径狭窄< 50%）。至少75%病例的坏死核心面积> 50岁，并且在高敏C反应蛋白水平升高的患者中。直到最近才认识到，在活着的患者中识别它们可能有助于降低冠心病猝死的发生率。
The majority of patients with acute coronary syndromes (ACS) present with unstable angina, acute myocardial infarction, and sudden coronary death. The most common cause of coronary thrombosis is plaque rupture followed by plaque erosion, whereas calcified nodule is infrequent. If advances in coronary disease are to occur, it is important to recognize the precursor lesion of ACS. Of the three types of coronary thrombosis, a precursor lesion for acute rupture has been postulated. The non-thrombosed lesion that most resembles the acute plaque rupture is the thin cap fibroatheroma (TCFA), which is characterized by a necrotic core with an overlying fibrous cap measuring < 65 mu m, containing rare smooth muscle cells but numerous macrophages. Thin cap fibroatheromas are most frequently observed in patients dying with acute myocardial infarction and least common in plaque erosion. They are most frequently observed in proximal coronary arteries, followed by mid and distal major coronary arteries. Vessels demonstrating TCFA do not usually show severe narrowing but show positive remodeling. In TCFAs the necrotic core length is approximately 2 to 17 mm (mean 8 mm) and the underlying cross-sectional area narrowing in over 75% of cases is < 75% (diameter stenosis < 50%). The area of the necrotic core in at least 75% of cases is 50 years, and in those patients with elevated high levels of high sensitivity C-reactive protein. It has only recently been recognized that their identification in living patients might help reduce the incidence of sudden coronary death.