Zhang Junyan, Chen Yong, Zhou Minggang, Cui Yunfeng, Wang Mian, Xiong Bo, Chen Yingzhong, Wang Hua, Chen Zhongxiu, He Yong
Department of Cardiology, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan, China.
Department of Cardiology Panzhihua Central Hospital, Panzhihua, Sichuan, China.
BMC Cardiovasc Disord. 2025 Sep 24;25(1):658. doi: 10.1186/s12872-025-05120-w.
The optimal treatment for vulnerable plaques with intraplaque hemorrhage (IPH) remains uncertain. The present article summarizes the treatment and prognosis of patients with refractory recurrent angina and rapid plaque progression due to IPH. All three cases pertained to rapid plaque progression due to IPH. In Case 1, a 43-year-old perimenopausal woman with two recent interventions for the left anterior descending coronary artery (LAD) was referred to our center for multiple recurrent angina episodes. In Case 2, a 49-year-old man presented to our center with complaints of recurrent chest pain for 7 months, with both coronary angiographies displaying mild-to-moderate stenosis. In Case 3, a 68-year-old woman was readmitted for recurrent angina, with both previous coronary angiographies displaying mild stenosis in the middle segment of LAD. Coronary artery spasm was initially considered; thus, anti-spasticity treatment was intensified. However, angina still frequently occurred during active medical treatment and was accompanied with dynamic ST-T changes on electrocardiography. Repeated diagnostic angiography revealed rapid plaque progression, and optical coherence tomography revealed intraplaque hemorrhage as a possible cause of plaque progression. Stenting was used to passivate vulnerable plaques, and the patients were symptom-free during clinical follow-up.
In vivo IPH associated with rapid plaque progression was observed in fibrotic plaques, which may leading to vasomotor dysfunction and refractory angina. In this specific patient population, stenting vulnerable plaques with intraplaque hemorrhage in patients experiencing recurrent angina, despite receiving intensified medical treatment, may be considered a potentially feasible and effective treatment strategy. Nevertheless, the efficacy and long-term outcomes of mechanical plaque sealing require further investigation.
伴有斑块内出血（IPH）的易损斑块的最佳治疗方法仍不确定。本文总结了因IPH导致难治性复发性心绞痛和斑块快速进展患者的治疗及预后情况。所有三例均与因IPH导致的斑块快速进展有关。病例1为一名43岁的围绝经期女性，近期因左前降支冠状动脉（LAD）接受了两次介入治疗，因多次复发性心绞痛发作被转诊至我们中心。病例2为一名49岁男性，因反复胸痛7个月就诊于我们中心，两次冠状动脉造影均显示轻度至中度狭窄。病例3为一名68岁女性，因复发性心绞痛再次入院，之前两次冠状动脉造影均显示LAD中段轻度狭窄。最初考虑为冠状动脉痉挛，因此强化了抗痉挛治疗。然而，在积极药物治疗期间心绞痛仍频繁发作，且心电图伴有动态ST-T改变。重复诊断性血管造影显示斑块快速进展，光学相干断层扫描显示斑块内出血可能是斑块进展的原因。采用支架置入术使易损斑块失活，临床随访期间患者无症状。
在纤维化斑块中观察到与斑块快速进展相关的体内IPH，这可能导致血管运动功能障碍和难治性心绞痛。在这一特定患者群体中，对于尽管接受强化药物治疗仍有复发性心绞痛且伴有斑块内出血的患者，置入易损斑块支架可能是一种潜在可行且有效的治疗策略。然而，机械性斑块封堵的疗效和长期结果仍需进一步研究。
