Fonseca Diogo A, Antunes Pedro E, Cotrim Maria D
aLaboratory of Pharmacology and Pharmaceutical Care, Faculty of Pharmacy bInstitute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine cCNC.IBILI, University of Coimbra dCentre of Cardiothoracic Surgery, Faculty of Medicine of Coimbra, University Hospital, Coimbra, Portugal.
Coron Artery Dis. 2017 Sep;28(6):518-527. doi: 10.1097/MCA.0000000000000527.
Coronary artery disease represents a major health problem worldwide for which coronary artery bypass surgery remains a standard of care. Among the several grafts that are available, the internal thoracic artery (ITA) has long been considered the best as several advantages have been described compared with other vessels (e.g. saphenous vein or radial artery), namely, an absent to minor atherosclerotic development. In fact, several studies showed the presence of preatherosclerotic lesions, such as intimal and/or medial thickening, medial fibrosis, among others, in the presence of certain cardiovascular risk factors as well as established atherosclerotic lesions (i.e. type II or more lesions). This paper primarily aimed at reviewing the current knowledge on the histomorphological characteristics of ITA as well as the comparative histomorphology of ITA with other vessel grafts currently in use in coronary surgery. As some of the evidence is not clear or consensual, this paper also aimed at reviewing the main histopathological, histomorphometrical, and ultrastructural findings in ITAs from patients with known cardiovascular risk factors (e.g. aging, obesity, hypertension, diabetes, smoking, and others). As the presence of preatherosclerotic and/or atherosclerotic lesions may compromise the success of the myocardial revascularization and lead to graft failure, contributing toward the associated morbidity and/or mortality, it is essential to improve the scientific knowledge on the structural characterization of ITAs and its correlation with the cardiovascular risk profile.
冠状动脉疾病是全球主要的健康问题，冠状动脉搭桥手术仍是其标准治疗方法。在可用的几种移植物中，胸廓内动脉（ITA）长期以来一直被认为是最佳选择，因为与其他血管（如大隐静脉或桡动脉）相比，它具有多种优势，即几乎没有或仅有轻微的动脉粥样硬化进展。事实上，多项研究表明，在存在某些心血管危险因素以及已确诊的动脉粥样硬化病变（即II型或更严重的病变）时，存在动脉粥样硬化前期病变，如内膜和/或中膜增厚、中膜纤维化等。本文主要旨在综述当前关于ITA组织形态学特征的知识，以及ITA与目前冠状动脉手术中使用的其他血管移植物的比较组织形态学。由于一些证据尚不明确或未达成共识，本文还旨在综述已知心血管危险因素（如衰老、肥胖、高血压、糖尿病、吸烟等）患者ITA的主要组织病理学、组织形态计量学和超微结构研究结果。由于动脉粥样硬化前期和/或动脉粥样硬化病变的存在可能会影响心肌血运重建的成功率并导致移植物失败，进而导致相关的发病率和/或死亡率，因此有必要提高对ITA结构特征及其与心血管风险状况相关性的科学认识。
