Raynaud P, Desveaux B, Pacouret G
Clinique Cardiologique, Hôpital Trousseau, Tours.
Ann Cardiol Angeiol (Paris). 1989 Sep 15;38(7):425-30.
Intracoronary thrombosis is more and more considered as a major etiological factor of unstable angina (UA). The physiopathological diagram from ulceration of the plaque to unstable then stable thrombosis is based on many arguments: pathological (Falk-Fuster), biological, angioscopic (Forrester) and finally angiographic; numerous studies have demonstrated the frequency of non-obstructive coronary thrombi in UA. Their frequency is directly related to the delay in control, in relation with the last painful episode, indicating the spontaneous lysis of the clot. This role suggests the beneficial effect of a thrombolytic treatment. Several non-randomized studies (Vetrovek, Mandelkorn, Gotoh, Vermeer) demonstrate reduction of the clots after thrombolysis. But considering spontaneous lysis, only randomized studies published to date (Gold, Topol and Nicklas) report encouraging results. More extended studies are necessary to specify the beneficial effect and the exact haemorrhagic risk of this treatment and the probable place of additional tests like transluminal coronary angioplasty (TCA) and aortocoronary by-pass.
冠状动脉内血栓形成越来越被认为是不稳定型心绞痛（UA）的主要病因。从斑块溃疡到不稳定然后稳定血栓形成的病理生理过程有诸多依据：病理学（法尔克 - 富斯特）、生物学、血管内镜检查（福雷斯特）以及最终的血管造影；众多研究已证实UA中非阻塞性冠状动脉血栓的发生率。其发生率与距上次疼痛发作后的控制延迟直接相关，这表明血栓会自发溶解。这一作用提示了溶栓治疗的有益效果。多项非随机研究（韦特罗韦克、曼德尔科恩、后藤、弗美尔）表明溶栓后血栓减少。但考虑到自发溶解，迄今为止发表的随机研究（戈尔德、托波尔和尼克拉斯）报告了令人鼓舞的结果。需要进行更广泛的研究以明确这种治疗的有益效果、确切的出血风险以及诸如经皮腔内冠状动脉成形术（TCA）和主动脉冠状动脉旁路移植术等附加检查可能发挥的作用。
