Nobuyoshi M, Kimura T, Ohishi H, Horiuchi H, Nosaka H, Hamasaki N, Yokoi H, Kim K
Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
J Am Coll Cardiol. 1991 Feb;17(2):433-9. doi: 10.1016/s0735-1097(10)80111-1.
Histopathologic examination was performed in 20 patients undergoing antemortem coronary angioplasty. Thirty-four lesions were dilated and the interval between coronary angioplasty and death ranged from several hours to 4 years. Intimal proliferation of smooth muscle cells, as a major cause of restenosis, was observed in 83% to 100% of 28 lesions examined 11 days to 2 years after coronary angioplasty. In 20 lesions examined within 6 months, proliferating smooth muscle cells were predominantly of the synthetic type and there was abundant extracellular matrix substance chiefly composed of proteoglycans. In eight lesions examined between 6 months and 2 years, contractile type smooth muscle cells were dominant and extracellular matrix was composed chiefly of collagen. In three lesions examined after 2 years, evidence of antemortem coronary angioplasty was hardly identifiable and these lesions were almost indistinguishable from conventional atherosclerotic plaque. These temporal changes in histologic pattern provide a pathologic background for clinical reports that restenosis is predominantly found within 6 months after coronary angioplasty. Morphometric analysis revealed that the extent of intimal proliferation was significantly greater in lesions with evidence of medial or adventitial tears than in lesions with no or only intimal tears.
对20例行生前冠状动脉成形术的患者进行了组织病理学检查。共扩张了34处病变，冠状动脉成形术与死亡之间的间隔时间从数小时至4年不等。在冠状动脉成形术后11天至2年检查的28处病变中，83%至100%观察到平滑肌细胞内膜增生，这是再狭窄的主要原因。在6个月内检查的20处病变中，增殖的平滑肌细胞主要为合成型，且有大量主要由蛋白聚糖组成的细胞外基质物质。在6个月至2年之间检查的8处病变中，收缩型平滑肌细胞占主导，细胞外基质主要由胶原蛋白组成。在2年后检查的3处病变中，生前冠状动脉成形术的证据几乎无法辨认，这些病变与传统动脉粥样硬化斑块几乎没有区别。组织学模式的这些时间变化为临床报告提供了病理背景，即再狭窄主要发生在冠状动脉成形术后6个月内。形态计量分析显示，有中膜或外膜撕裂证据的病变内膜增生程度明显大于无撕裂或仅有内膜撕裂的病变。
