Atheromas that cause fatal thrombosis are usually large and frequently accompanied by vessel enlargement
Atheromas that cause fatal thrombosis are usually large and frequently accompanied by vessel enlargement
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DOI：
10.1016/s1054-8807(01)00070-9
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发表时间：
2001-07-01
影响因子：
3.7
通讯作者：
Ramires, JAF
中科院分区：
文献类型：
--
作者：
Bezerra, HG;Higuchi, MD;Ramires, JAF
多项临床证据表明，急性心肌梗死多发生在冠脉轻度至中度狭窄的部位。管腔狭窄的程度取决于斑块沉积和血管重塑的程度，而冠脉造影术很难评估这些特征。这项尸检研究验证了一种假设，即冠状动脉动脉粥样硬化的大小和重塑类型区分了同一冠状动脉树中致死性急性心肌梗死的罪魁祸首病变和等狭窄的非罪魁祸首病变。本文对36例致死性急性心肌梗死患者的冠状动脉主干进行了研究。对同一患者的另一支冠状动脉测量得到的罪犯病变(组1)和等狭窄的非罪犯节段(组2)进行了比较。对两组患者进行形态计量学和斑块成分评估。与第2组相比，第1组斑块面积为9.6 mm比4.7 mm(2)，血管面积12.7 mm比7.4 mm(2)，管腔面积1.7比1.2 mm(2)(P<；0.01)。I组的正性重构发生率高于2组：21/30(70%)对8/26(31%)。斑块面积与脂核、巨噬细胞呈正相关，与纤维化、平滑肌细胞呈负相关。导致致命性血栓形成的动脉粥样硬化斑块更常被积极重塑，而且往往比横断面狭窄程度相同的非罪魁祸首斑块更大。我们测试了动脉重构和斑块大小是否在含有致命性血栓斑块的节段和等狭窄的非罪魁祸首斑块之间存在差异。罪魁祸首血管段的内膜斑块和管壁横截面积高于等狭窄的非罪魁祸首斑块。血管横截面积与脂核面积和CD68(+)巨噬细胞含量呈正相关，与纤维化面积和平滑肌细胞含量呈负相关。这些结果增加了解释血管造影术在识别斑块方面的局限性的因素，并为斑块重塑在斑块不稳定性中的作用提供了新的见解。(C)2001 Elsevier Science Inc.保留所有权利。
Several lines of clinical evidence show that AMI frequently occurs at sites with mild to moderate degree of coronary stenosis. The degree of luminal stenosis depends on plaque deposition and degree of vessel remodeling, features poorly assessed by coronary angiography. This postmortem study tested the hypothesis that the size of coronary atheroma and the type of remodeling distinguish culprit lesion responsible for fatal AMI from equi-stenotic nonculprit lesion in the same coronary tree. The main coronary branches from 36 consecutive patients with fatal AMI were studied. The culprit lesion (Group 1) and an equi-stenotic nonculprit segment (Group 2) obtained in measurements of another coronary branch from the same patient were compared. Morphometry and plaque composition was assessed in both groups. Compared to Group 2, Group 1 had larger areas of plaque 9.6 vs. 4.7 mm(2), vessel 12.7 vs. 7.4 mm(2) and lumen 1.7 vs. 1.2 mm(2); (P < .01). Positive remodeling was more frequent in Group I than Group 2: 21/30 (70%) vs. 8/26 (31%). Plaque area correlated positively with lipid core and macrophages and negatively with fibrosis and smooth muscle cells. Atherosclerotic plaques that cause fatal thrombosis are more frequently positively remodeled and tend to be larger than nonculprit plaques with the same degree of cross-sectional stenosis. We tested whether arterial remodeling and plaque size vary between segments containing a fatal thrombosed plaque versus an equi-stenotic nonculprit plaque. Culprit vessel segments had higher cross-sectional areas of intimal plaque and of vessel wall than equi-stenotic nonculprit plaques. The cross-sectional area of the vessel correlated positively with both the lipid core area and CD68(+) macrophage content, and negatively with fibrosis area and smooth muscle cell content. These results add elements explaining limitations of angiography in identifying plaques and provide new insights into the role of remodeling in plaque instability. (C) 2001 Elsevier Science Inc. All rights reserved.