RELATIONSHIP BETWEEN CORONARY-ARTERY LESIONS AND MYOCARDIAL INFARCTS ULCERATION OF ATHEROSCLEROTIC PLAQUES PRECIPITATING CORONARY THROMBOSIS
RELATIONSHIP BETWEEN CORONARY-ARTERY LESIONS AND MYOCARDIAL INFARCTS ULCERATION OF ATHEROSCLEROTIC PLAQUES PRECIPITATING CORONARY THROMBOSIS
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DOI：
10.1016/s0002-8703(77)80410-9
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发表时间：
1977-01-01
影响因子：
4.8
通讯作者：
HUTCHINS, GM
中科院分区：
文献类型：
--
作者：
RIDOLFI, RL;HUTCHINS, GM
对 494 例一维至少 3 cm 的人类心肌病变进行回顾显示，418 例（85%）与动脉粥样硬化性冠状动脉病变相关，55 例（11%）与各种类型的冠状动脉栓塞相关，18 例（3.5%）无特定冠状动脉病变，但与冠状动脉灌注不足相关的临床事件相关，3 例（0.5%）与其他冠状动脉病变相关。在所有年龄段的 418 例动脉粥样硬化冠状动脉病变中，有 399 例 (96%) 存在完全闭塞（远端或新鲜）或管腔再通的组织学证据。这些冠状动脉病变位于距心肌病变近端一到几厘米的壁外冠状动脉段内，其分布仅限于相应部分或完全闭塞的冠状动脉段的分布。在不到 2 周的动脉粥样硬化冠状动脉病变中，69 例中有 67 例 (97%) 发现部分或完全闭塞的血栓，69 例中有 64 例 (93%) 存在潜在的斑块溃疡、糜烂或破裂。这些内皮和内膜损伤本质上通常是局灶性的，通常延伸的长度仅100-200μm。动脉粥样硬化性溃疡-血栓复合体中最古老的部分在年龄上不一定比其相关的心肌病变年轻。在 69 例病例中，有 10 例 (14%) 的冠状动脉血栓部分（通常位于斑块溃疡部位）在组织学上比心肌病变更老。血栓和斑块碎片混合物的存在进一步表明冠状动脉病变与心肌病变相关的先行性质。与 2-8 周龄心肌病变相关的动脉粥样硬化冠状动脉病变在所有病例中均具有可识别的血栓，21 例中有 17 例 (80%) 存在潜在的斑块溃疡、糜烂或破裂。由于组织性腔内血栓的模糊特征，内皮损伤更难以评估。界面损伤，即斑块溃疡、糜烂或破裂，可在大约 1 个月内可靠地检测到。的年龄。冠状动脉血栓栓塞占心肌病变的很大比例，通常与正常或轻微冠状动脉疾病相关，并且经常累及心脏的较小壁内冠状血管。血栓栓塞的组织和再通往往是快速且完全的，因此在晚期，残留的内膜斑块有时难以识别。与冠状动脉低灌注相关的临床事件相关的心肌病变通常是心内膜下的、斑片状的、多中心的，并且不局限于单个冠状动脉的分布。它们与急性冠状动脉病变无关，并且组织学显示收缩带坏死比栓塞和动脉粥样硬化相关病变更频繁。最显着的是，在动脉粥样硬化冠状动脉血栓形成中，潜在的诱发事件和血栓形成的巢穴似乎是局灶性内皮损伤，通常以斑块溃疡、侵蚀或破坏的形式表现。在 82 例与心肌梗死相关的动脉病变中，有 76 例 (93%) 发现了诸如此类的界面损伤，导致冠状动脉血栓形成，时间少于 1 个月。的年龄。
A review of 494 human myocardial lesions at least 3 cm in one dimension revealed 418 (85%) related to atherosclerotic coronary lesions, 55 (11%) related to coronary emboli of various types, 18 (3.5%) without specific coronary lesions but related to clinical events associated with coronary hypoperfusion, and 3 (0.5%) associated with miscellaneous coronary lesions. In 399 of 418 (96%) atherosclerotic coronary lesions of all ages complete occlusion (remote or fresh) or histological evidence of lumenal recanalization was present. These coronary lesions were situated within extramural coronary artery segments one to several centimeters proximal to the myocardial lesions which were confined to the distribution of the respective partially or totally occluded coronary segments. In the atherosclerotic coronary lesions less than 2 wk of age partially or totally occlusive thrombus was found in 67 of 69 (97%) cases and an underlying plaque ulceration, erosion, or rupture was present in 64 of 69 (93%) instances. These endothelial and intimal injuries were generally focal in nature, often extending over a length of only 100-200 .mu.m. The oldest portion of the atherosclerotic ulceration-thrombus complex was not necessarily younger in age than its associated myocardial lesion. In 10 of 69 (14%) cases portions of the coronary thrombus, usually at the site of plaque ulceration, were histologically older than the myocardial lesion. The presence of thrombus and plaque debris admixtures further suggested the antecedent nature of the coronary lesion in relation to the myocardial lesion. Atherosclerotic coronary lesions associated with myocardial lesions of 2-8 wk of age had identifiable thromboses in all instances and underlying plaque ulcerations, erosions, or ruptures in 17 of 21 (80%). Endothelial injuries were more difficult to assess due to the obscuring features of organizing lumenal thrombus. Interface injuries, i.e., plaque ulcerations, erosions or ruptures, were reliably detectable up to approximately 1 mo. of age. Coronary artery thromboemboli accounted for a significant percentage of myocardial lesions, were usually associated with normal or minimal coronary artery disease, and frequently involved smaller intramural coronary vessels of the heart. Organization and recanalization of thromboemboli tended to be rapid and complete so that in the late stages the residual intimal plaque was sometimes difficult to identify. Myocardial lesions related to clinical events associated with coronary artery hypoperfusion were generally subendocardial, patchy, multicentric, and not confined to the distribution of a single coronary artery. They were unassociated with acute coronary lesions and histologically displayed contraction band necrosis more frequently than the embolic and atherosclerotic related lesions. Most significantly in atherosclerotic coronary thrombosis the underlying precipitating event and nidus for thrombus formation appeared to be focal endothelial injury, usually manifest in the form of plaque ulceration, erosion or disruption. Interface injuries such as these were found underlying coronary thrombosis in 76 of 82 (93%) arterial lesions associated with myocardial infarcts less than 1 mo. of age.