Garratt K N, Edwards W D, Kaufmann U P, Vlietstra R E, Holmes D R
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
J Am Coll Cardiol. 1991 Feb;17(2):442-8. doi: 10.1016/s0735-1097(10)80113-5.
Vascular tissue obtained using a directional percutaneous atherectomy device was examined microscopically. Tissue was obtained from coronary arteries without prior instrumentation (primary lesions, n = 31), aortocoronary saphenous vein bypass grafts with primary lesions (n = 8), coronary arteries with lesions developing after prior balloon angioplasty or mechanical atherectomy (restenotic lesions, n = 30) and vein bypass grafts with restenotic lesions (n = 4). Primary lesions were characterized by dense intimal fibrosis with necrotic debris (83% of intimal tissue) and foam cells typical of atherosclerosis. These lesions frequently contained cholesterol crystals (45% of coronary arteries, 50% of vein grafts) and calcium deposits (65% of coronary arteries, 38% of vein grafts). Restenotic lesions were characterized by an increased proportion of loose fibroproliferative tissue (45% of coronary artery intima, 35% of vein graft intima). Immunohistochemical stains confirmed this proliferative tissue to be primarily smooth muscle cells. Thrombus was rarely observed. Comparison of resected tissues indicated that dense fibrosis and necrosis are significantly more common in primary than in restenotic lesions (83% versus 56% of intimal tissue, p = 0.0005), whereas smooth muscle cell hyperplasia is more common in restenotic than in primary lesions (44% versus 17% of intimal tissue, p less than 0.0005). Partial-thickness resection of medial tissue or full-thickness resection of media with associated adventitial tissue occurred in 27 (56%) of 39 primary atheromatous lesions and 16 (47%) of 34 restenotic lesions; subintimal tissue obtained from primary lesions appeared identical to that obtained from restenotic lesions. These data indicate that the histopathologic characteristics of the neointimal layer of restenotic lesions differ from those of the intimal layer of primary atherosclerotic lesions.(ABSTRACT TRUNCATED AT 250 WORDS)
使用定向经皮斑块旋切装置获取的血管组织进行了显微镜检查。组织取自未经预先器械操作的冠状动脉（原发性病变，n = 31）、有原发性病变的主动脉冠状动脉大隐静脉旁路移植血管（n = 8）、先前球囊血管成形术或机械斑块旋切术后出现病变的冠状动脉（再狭窄病变，n = 30）以及有再狭窄病变的静脉旁路移植血管（n = 4）。原发性病变的特征为伴有坏死碎片的致密内膜纤维化（占内膜组织的83%）以及动脉粥样硬化典型的泡沫细胞。这些病变常含有胆固醇结晶（45%的冠状动脉、50%的静脉移植血管）和钙沉积（65%的冠状动脉、38%的静脉移植血管）。再狭窄病变的特征为疏松纤维增生组织比例增加（冠状动脉内膜的45%、静脉移植血管内膜的35%）。免疫组织化学染色证实这种增生组织主要为平滑肌细胞。很少观察到血栓。切除组织的比较表明，致密纤维化和坏死在原发性病变中比在再狭窄病变中显著更常见（内膜组织的83%对56%，p = 0.0005），而平滑肌细胞增生在再狭窄病变中比在原发性病变中更常见（内膜组织的44%对17%，p小于0.0005）。39例原发性动脉粥样硬化病变中的27例（56%）和34例再狭窄病变中的16例（47%）发生了中层组织的部分厚度切除或中层与相关外膜组织的全层切除；取自原发性病变的内膜下组织与取自再狭窄病变的内膜下组织看起来相同。这些数据表明，再狭窄病变新生内膜层的组织病理学特征与原发性动脉粥样硬化病变内膜层的组织病理学特征不同。（摘要截取自250字）
