Ueda Yasunori, Hirayama Atsushi, Kodama Kazuhisa
Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.
Herz. 2003 Sep;28(6):501-4. doi: 10.1007/s00059-003-2486-8.
When observed by angioscopy, the culprit lesions of acute coronary syndrome (ACS) have a common appearance of a yellow plaque with irregular surface covered by a thrombus. Angioscopy is a powerful device to detect not only the ruptured plaques at ACS lesions but also the yellow plaques in their early stages. The culprit lesions of ACS are sometimes detected by angioscopy even in the angiographically normal segments of coronary arteries. Angioscopy can further classify the culprit lesions of ACS as (1) vasospasm, (2) plaque rupture, or (3) plaque erosion according to the angioscopic definitions. These classifications may be beneficial to determine the treatment strategy. Anti-vasospastic medications rather than stenting may be more suitable for the treatment of vasospasm-induced ACS. Percutaneous coronary intervention (PCI) of ruptured plaque rather than of erosive plaque tends to cause more distal embolization with thrombus and plaque contents. Therefore, distal protection device may be more beneficial for those cases. Although angioscopy may be able to identify vulnerable plaques as the plaques of intensive yellow color, it may be more practical to identify the patients at high risk of suffering ACS by evaluating the extent of coronary atherosclerosis. The process and the time course of plaque formation, maturation, and disruption are left to be clarified, however, the number of yellow plaques or the yellow color intensity of those plaques may be a marker of coronary atherosclerosis. Angioscopy should be useful not only as a diagnostic tool but also as an investigational tool. The effect of medications that regress coronary atherosclerosis may be evaluated by the angioscopically determined markers of coronary atherosclerosis.
通过血管内镜观察时，急性冠状动脉综合征（ACS）的罪犯病变通常表现为表面不规则且覆盖有血栓的黄色斑块。血管内镜不仅是检测ACS病变处破裂斑块的有力工具，也是检测早期黄色斑块的有力工具。即使在冠状动脉造影正常的节段，有时也能通过血管内镜检测到ACS的罪犯病变。根据血管内镜的定义，血管内镜可将ACS的罪犯病变进一步分类为：（1）血管痉挛，（2）斑块破裂，或（3）斑块侵蚀。这些分类可能有助于确定治疗策略。抗血管痉挛药物而非支架置入术可能更适合治疗血管痉挛诱发的ACS。破裂斑块而非侵蚀性斑块的经皮冠状动脉介入治疗（PCI）往往会导致更多血栓和斑块成分的远端栓塞。因此，远端保护装置可能对这些病例更有益。尽管血管内镜可能能够将易损斑块识别为颜色较深的黄色斑块，但通过评估冠状动脉粥样硬化的程度来识别ACS高危患者可能更具实用性。然而，斑块形成、成熟和破裂的过程及时间进程仍有待阐明，黄色斑块的数量或这些斑块的黄色强度可能是冠状动脉粥样硬化的一个标志物。血管内镜不仅应作为一种诊断工具，还应作为一种研究工具。可通过血管内镜确定的冠状动脉粥样硬化标志物来评估使冠状动脉粥样硬化消退的药物的疗效。
