Mizuno K, Miyamoto A, Satomura K, Kurita A, Arai T, Sakurada M, Yanagida S, Nakamura H
First Department of Internal Medicine, National Defense Medical College, Saitama, Japan.
Lancet. 1991 Apr 6;337(8745):809-12. doi: 10.1016/0140-6736(91)92514-3.
To investigate the pathogenesis of acute coronary disorders and to clarify what type of plaque precedes these disorders, percutaneous transluminal coronary angioscopy, by means of a new angioscope, was carried out during catheterisation in 100 consecutive patients anatomically suitable for such investigations. The quality of the angioscopic image was good enough for analysis in 84 patients (14 with acute myocardial infarction [within 8 h of onset], 16 with recent myocardial infarction [3 days-2 months since onset], 24 with old myocardial infarctions, 10 with unstable angina, and 20 with stable angina). Thrombi were observed in most patients with acute coronary disorders (all 14 with acute myocardial infarction, 9 of 10 with unstable angina). Occlusive thrombi were more common in patients with acute myocardial infarction than in those with unstable angina (11 [79%] vs 1 [10%]; p less than 0.001), whereas mural (non-occlusive) thrombi were more common in the unstable angina than in the acute myocardial infarction group (8 [80%] vs 3 [21%]; p less than 0.001). Xanthomatous ulcerated plaques or ragged irregular surfaces were seen in patients with acute coronary disorders and in those with recent myocardial infarction. Xanthomatous plaques were more common in patients with acute coronary disorders (50%) than in those with stable angina (15%) or old myocardial infarction (8%). By contrast white and smooth plaques were seen in cases of stable angina and old myocardial infarction. Angioscopy could display the intracoronary lumen more precisely than could coronary arteriography. This angioscopic study suggested that, although a thrombus overlying a rupture in the lining of the plaque was common in both unstable angina and acute myocardial infarction, the character of the thrombus may differ between these disorders, and lipid-rich xanthomatous plaque may precede rupture.
为研究急性冠状动脉疾病的发病机制，并明确何种类型的斑块先于这些疾病出现，我们使用一种新型血管镜，对100例解剖结构适合此类检查的连续患者在导管插入术期间进行了经皮腔内冠状动脉血管镜检查。血管镜图像质量足以供84例患者进行分析（14例急性心肌梗死[发病8小时内]，16例近期心肌梗死[发病3天至2个月]，24例陈旧性心肌梗死，10例不稳定型心绞痛，20例稳定型心绞痛）。在大多数急性冠状动脉疾病患者中观察到血栓（14例急性心肌梗死患者全部有血栓，10例不稳定型心绞痛患者中有9例有血栓）。闭塞性血栓在急性心肌梗死患者中比在不稳定型心绞痛患者中更常见（11例[79%]对1例[10%]；p<0.001），而壁内（非闭塞性）血栓在不稳定型心绞痛患者中比在急性心肌梗死组中更常见（8例[80%]对3例[21%]；p<0.001）。在急性冠状动脉疾病患者和近期心肌梗死患者中可见黄色瘤样溃疡斑块或参差不齐的不规则表面。黄色瘤样斑块在急性冠状动脉疾病患者中（50%）比在稳定型心绞痛患者（15%）或陈旧性心肌梗死患者（8%）中更常见。相比之下，在稳定型心绞痛和陈旧性心肌梗死病例中可见白色光滑斑块。血管镜检查比冠状动脉造影能更精确地显示冠状动脉内腔。这项血管镜研究表明，虽然斑块内膜破裂处覆盖的血栓在不稳定型心绞痛和急性心肌梗死中都很常见，但这些疾病中血栓的特征可能不同，富含脂质的黄色瘤样斑块可能先于破裂出现。
