Zhao Han-Jun, Yan Hong-Bing, Li Di, Liu Chen, Li Wen-Zheng, Ma Qin, Wang Wei, Wang Jian, Li Qing-Xiang, Li Shi-Ying, Chi Yun-Peng, Wu Zheng, Chen Dong
28th Division, Beijing Anzhen Hospital, Capital Medical University, Institute of Beijing Heart, Lung and Blood Vessel Disease, Beijing 100029, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2009 Sep;37(9):785-9.
To analyze the components of retrieved materials from the culprit lesion in ST-segment elevation myocardial infarction (STEMI) patients by manual aspiration during primary percutaneous coronary intervention (PCI).
Visible retrieved materials were collected, fixed in formalin and processed for paraffin embedding, sectioned and stained with hematoxylin and eosin (HE). The retrieved materials were microscopically divided into erythrocyte-rich thrombi, platelet/fibrin-rich thrombi, combined thrombi (similar proportions of erythrocytes and platelet/fibrin components), atherosclerotic plaque materials and edematous components. Based on pathological findings, thrombus materials were classified into fresh (< 1 d), lytic (1-5 d), fresh/lytic and organized thrombi (> 5 d) after formation. All patients were further classified into plaque positive and plaque negative groups. Clinical and angiographic data were also obtained for analyzing possible association between pathological findings and surrogates of myocardial reperfusion, including myocardial blush grade (MBG), enzymatic estimated infarction size (peak CK and CK-MB levels), left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) which were assessed 16 h after procedure.
Visible samples were collected from 49 patients by manual catheter aspiration (thrombus components in 46 patients, atherosclerotic plaque only in 3 patients). Frequency of erythrocyte-rich thrombi, platelet/fibrin-rich thrombi and combined thrombi were 41.3% (19/46), 30.4% (14/46) and 28.2% (13/46), respectively. The incidence of fresh, lytic, fresh/lytic and organized thrombi were 47.8% (22/46), 32.6% (15/46), 10.9% (5/46) and 8.7% (4/46), respectively. Plaque materials were found in 57.1% (28/49) patients, including ruptured plaque accompanied by thrombus formation [8.2% (4/49)], fibrous plaque [6.1% (3/49)] and thickened intima [2.0% (1/49)]. Baseline characteristics did not differ between plaque positive (n = 28) and plaque negative (n = 21) groups. Ratios of MBG 3 were higher in plaque positive group than in plaque negative group [82.1% (23/28) vs. 52.4% (11/21), P = 0.025]. Peak CK and CK-MB levels were lower in the former than in the later [(1705 +/- 1647) U/L vs. (2629 +/- 2013) U/L, P = 0.042; (146 +/- 136) microg/L vs. (258 +/- 215) microg/L, P = 0.016; respectively]. Furthermore, LVEF were higher in plaque positive group than in plaque negative group (0.59 +/- 0.10 vs. 0.52 +/- 0.08, P = 0.012).
Manual catheter aspiration during primary PCI in STEMI patients is an effective way for removing thrombus and plaque materials, and plaque debulking before stenting or pre-dilation and this procedure might probably improve myocardial reperfusion, limit infarction size and improve cardiac function.
分析ST段抬高型心肌梗死（STEMI）患者在直接经皮冠状动脉介入治疗（PCI）期间通过手动抽吸从罪犯病变处获取的物质成分。
收集可见的获取物质，用福尔马林固定并进行石蜡包埋、切片，然后用苏木精和伊红（HE）染色。将获取物质在显微镜下分为富含红细胞的血栓、富含血小板/纤维蛋白的血栓、混合血栓（红细胞与血小板/纤维蛋白成分比例相似）、动脉粥样硬化斑块物质和水肿成分。根据病理结果，血栓物质在形成后分为新鲜血栓（<1天）、溶解血栓（1 - 5天）、新鲜/溶解血栓和机化血栓（>5天）。所有患者进一步分为斑块阳性组和斑块阴性组。还获取了临床和血管造影数据，以分析病理结果与心肌再灌注指标之间可能的关联，包括心肌灌注分级（MBG）、酶学估计梗死面积（肌酸激酶（CK）和肌酸激酶同工酶（CK - MB）峰值水平）、左心室舒张末期内径（LVEDD）和左心室射血分数（LVEF），这些指标在术后16小时进行评估。
通过手动导管抽吸从49例患者中获取了可见样本（46例患者中有血栓成分，3例患者仅有动脉粥样硬化斑块）。富含红细胞的血栓、富含血小板/纤维蛋白的血栓和混合血栓的出现频率分别为41.3%（19/46）、30.4%（14/46）和28.2%（13/46）。新鲜血栓、溶解血栓、新鲜/溶解血栓和机化血栓的发生率分别为47.8%（22/46）、32.6%（15/46）、10.9%（5/46）和8.7%（4/46）。在57.1%（28/49）的患者中发现了斑块物质，包括伴有血栓形成的破裂斑块[8.2%（4/49）]、纤维斑块[6.1%（3/49）]和内膜增厚[2.0%（1/49）]。斑块阳性组（n = 28）和斑块阴性组（n = 21）的基线特征无差异。斑块阳性组MBG 3级的比例高于斑块阴性组[82.1%（23/28）对52.4%（11/21），P = 0.025]。前者的CK和CK - MB峰值水平低于后者[（1705±1647）U/L对（2629±2013）U/L，P = 0.042；（146±136）μg/L对（258±215）μg/L，P = 0.016]。此外，斑块阳性组的LVEF高于斑块阴性组（0.59±0.10对0.52±0.08，P = 0.012）。
STEMI患者在直接PCI期间进行手动导管抽吸是清除血栓和斑块物质的有效方法，并且在支架置入或预扩张前进行斑块减容，该操作可能会改善心肌再灌注、限制梗死面积并改善心功能。
