Garratt K N, Edwards W D, Vlietstra R E, Kaufmann U P, Holmes D R
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
J Am Coll Cardiol. 1990 Nov;16(6):1432-6. doi: 10.1016/0735-1097(90)90388-6.
The morphologic basis of angiographically successful percutaneous directional atherectomy and subsequent restenosis in human coronary arteries is unknown. The clinical and pathologic features of three patients who died after coronary atherectomy are described. Tissue fragments obtained with atherectomy demonstrated atheromatous and fibroproliferative intima, media and adventitia. At autopsy, treated vascular segments (from the left anterior descending artery in two patients and a vein graft in one patient) demonstrated discrete defects in the vascular wall. Defects extending into atheroma, media or adventitia corresponded with the presence of these tissues in the atherectomy specimens. Tissues were otherwise not disrupted in the manner associated with balloon angioplasty. Acute mural thrombus deposition was evident in the resection zone in one patient. Late findings included fibroproliferative intimal tissue extending from the resected areas into the vascular lumen. In one patient intimal hyperplasia was sufficient to narrow the vascular lumen by 82% and was implicated in subsequent myocardial ischemia and infarction. The study indicates that 1) the vascular injury associated with atherectomy is distinct from that associated with balloon angioplasty, 2) acute mural thrombus deposition may occur even with resection limited to the intima, and 3) intimal hyperplasia may develop in regions treated with atherectomy and may be associated with late myocardial ischemia and infarction.
经皮定向冠状动脉斑块旋切术在血管造影上获得成功以及随后发生再狭窄的形态学基础尚不清楚。本文描述了3例冠状动脉斑块旋切术后死亡患者的临床和病理特征。斑块旋切术获取的组织碎片显示有动脉粥样硬化和纤维增生性的内膜、中膜和外膜。尸检时，治疗过的血管节段（2例患者的左前降支和1例患者的静脉移植物）显示血管壁有离散性缺损。延伸至动脉粥样硬化、中膜或外膜的缺损与斑块旋切术标本中这些组织的存在相对应。除此之外，组织并未以与球囊血管成形术相关的方式受到破坏。1例患者的切除区域有明显的急性壁血栓形成。晚期表现包括从切除区域延伸至血管腔的纤维增生性内膜组织。1例患者的内膜增生足以使血管腔狭窄82%，并与随后的心肌缺血和梗死有关。该研究表明，1）与斑块旋切术相关的血管损伤不同于与球囊血管成形术相关的血管损伤；2）即使切除仅限于内膜，也可能发生急性壁血栓形成；3）斑块旋切术治疗区域可能会出现内膜增生，并可能与晚期心肌缺血和梗死有关。
