Vulnerable plaque: the pathology of unstable coronary lesions.
Vulnerable plaque: the pathology of unstable coronary lesions.
复制标题
DOI：
10.1111/j.1540-8183.2002.tb01087.x
复制
发表时间：
2002-12-01
影响因子：
2.1
通讯作者：
Farb, Andrew
中科院分区：
文献类型：
--
作者：
Virmani, Renu;Burke, Allen P;Farb, Andrew
易损斑块被定义为破裂病变的前兆。然而，冠状动脉血栓形成可能发生于其他病变，如斑块糜烂和钙化结节，尽管其发生率低于破裂。因此，易损斑块的定义应该是包罗万象的。使用描述性术语，作者将斑块破裂的前驱病变定义为“薄帽纤维粥样硬化”（TCFA）。在形态学上，TCFA有一个坏死的核心，上面有一个薄的纤维帽（< 65 mm），由I型胶原组成，被巨噬细胞浸润。这些病变在急性心肌梗死死亡患者的冠状动脉树中最常见，在斑块糜烂患者中最不常见。TCFA更常见于血清总胆固醇（TC）和TC/高密度胆固醇比值高的患者、> 50岁的女性以及高敏C反应蛋白水平升高的患者。TCFA主要见于冠状动脉左前降支近端，较少见于右冠状动脉近端或左回旋支近端。在TCFA中，坏死核心长度约为2-17 mm（平均8 mm），75%以上病例的基础横截面管腔狭窄< 75%（直径狭窄< 50%）。至少75%病例的坏死中心面积≤ 3 mm 2。由于血管造影和血管内超声（IVUS）导管无法准确识别这些病变，因此TCFA的临床研究有限。较新的导管和其他技术正处于不同的发展阶段，将在了解斑块进展和症状性冠状动脉疾病的发展方面发挥重要作用。
Vulnerable plaques have been defined as precursors to lesions that rupture. However, coronary thrombosis may occur from other lesions like plaque erosion and calcified nodules, although to a lesser frequency than rupture. Therefore, the definition of vulnerable plaque should be all-inclusive. Using descriptive terminology, the authors define the precursor lesion of plaque rupture as "thin-cap fibroatheroma" (TCFA). Morphologically, TCFAs have a necrotic core with an overlying thin fibrous cap (< 65 mm) consisting of collagen type I, which is infiltrated by macrophages. These lesions are most frequent in the coronary tree of patients dying with acute myocardial infarction and least common in those with plaque erosion. TCFAs are more common in patients with high serum total cholesterol (TC) and a high TC to high density cholesterol ratio, in women > 50 years, and in those patients with elevated levels of high sensitivity C-reactive protein. TCFAs are mostly found in the proximal left anterior descending coronary arteries and less commonly in the proximal right or the proximal left circumflex coronary arteries. In TCFAs, necrotic core length is approximately 2-17 mm (mean 8 mm) and the underlying cross-sectional luminal narrowing in over 75% of cases is < 75% (< 50% diameter stenosis). The area of the necrotic core in at least 75% of cases is < or = 3 mm2. Clinical studies of TCFAs are limited as angiography and intravascular ultrasound (IVUS) catheters cannot precisely identify these lesions. Newer catheters and other techniques are at various stages of development and will play a significant role in the understanding of plaque progression and the development of symptomatic coronary artery disease.