Rigatelli Gianluca, Zuin Marco, Ngo Tra T, Nguyen Hung T, Nanjundappa Aravinda, Talarico Ernest, Duy Le Cao Phuong, Nguyen Thach
Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy.
Section of Internal and Cardiopulmonary Medicine, University of Ferrara, Ferrara, Italy.
J Transl Int Med. 2019 Jul 11;7(2):69-75. doi: 10.2478/jtim-2019-0014. eCollection 2019 Jun.
Significant rather than moderate coronary artery stenosis has been postulated to be the main substrate of plaque rupture in acute myocardial infarction (AMI). We evaluate if cavitation could influence the coronary artery plaque rupture contributing to the progression of thrombotic process.
We reconstructed a 3D model of the left anterior descending coronary artery (LAD) after reviewing the intravascular ultrasound (IVUS) data of 30 consecutive patients with mild to severe coronary artery disease.
Turbulent flow or cavitation occurs in both concentric and eccentric coronary artery stenosis (≥ 75% for the former and ≥ 50% for the latter). The analysis of vapor phase demonstrated that cavitation propagated downstream, creating microbubbles, which exploded when the fluid pressure was lower than the vapor pressure at a local thermodynamic state. The relative higher vorticity magnitude (as turbulent flow in vivo angiogram) observed on the distal cap of the atherosclerotic plaque created a higher turbulence, probably able to destabilize the plaque through a micro-erosion process.
Cavitation seems to be able to promote the thrombotic occlusion within the coronary vessels due the 'constant injuries' created by the micro-explosion of bubbles.
有假设认为，严重而非中度冠状动脉狭窄是急性心肌梗死（AMI）中斑块破裂的主要基础。我们评估空化是否会影响冠状动脉斑块破裂，进而促使血栓形成过程的进展。
在回顾了30例轻至重度冠状动脉疾病患者的血管内超声（IVUS）数据后，我们重建了左前降支冠状动脉（LAD）的三维模型。
在同心和偏心冠状动脉狭窄（前者≥75%，后者≥50%）中均会出现湍流或空化现象。对气相的分析表明，空化会向下游传播，产生微气泡，当流体压力低于局部热力学状态下的蒸气压时，微气泡会爆炸。在动脉粥样硬化斑块远端帽上观察到的相对较高的涡度值（如体内血管造影中的湍流）产生了更高的湍流，可能通过微侵蚀过程使斑块不稳定。
由于气泡的微爆炸造成“持续损伤”，空化似乎能够促进冠状动脉内的血栓形成阻塞。
