Holmes D R, Hartzler G O, Smith H C, Fuster V
Br Heart J. 1981 Apr;45(4):411-6. doi: 10.1136/hrt.45.4.411.
This report describes the clinical course, coronary artery anatomy, and ventricular function of 16 patients in whom coronary artery thrombosis was detected at the time of cardiac catheterisation. All patients had an unstable clinical course in which accelerated angina occurred a mean of four weeks (range four days to 12 weeks) before catheterisation, and four patients had recent subendocardial myocardial infarction. In all patients severe coronary artery disease was documented at catheterisation. Fifteen patients had segmental wall motion abnormalities involving the left ventricular wall that was supplied by the coronary artery in which there was thrombus. Three patterns of coronary artery thrombus were noted: (1) Thrombus proximal to high-grade coronary artery stenosis; (2) thrombus distal to high-grade coronary artery stenosis; and (3) thrombus in segments of the arterial tree in which there was no high-grade coronary artery stenosis. Though the precise cause of the coronary artery thrombosis in our patients is unknown, it may have been a result of stasis, a ruptured atherosclerotic plaque, or coronary spasm. The common clinical course with unstable angina of acute onset suggests the possibility that the thrombus may have been responsible for the abrupt change in clinical condition or may have been a contributing factor in the patients' course.
本报告描述了16例在心脏导管插入术时检测到冠状动脉血栓形成患者的临床病程、冠状动脉解剖结构和心室功能。所有患者临床病程均不稳定，在导管插入术前平均四周（范围为四天至12周）出现加速性心绞痛，4例患者近期发生心内膜下心肌梗死。所有患者在导管插入术时均记录有严重冠状动脉疾病。15例患者出现节段性室壁运动异常，累及血栓所在冠状动脉供血的左心室壁。观察到三种冠状动脉血栓模式：（1）高度冠状动脉狭窄近端的血栓；（2）高度冠状动脉狭窄远端的血栓；（3）动脉树节段中无高度冠状动脉狭窄的血栓。尽管我们患者冠状动脉血栓形成的确切原因尚不清楚，但可能是血流淤滞、动脉粥样硬化斑块破裂或冠状动脉痉挛所致。急性发作的不稳定型心绞痛这一常见临床病程提示，血栓可能是导致临床状况突然改变的原因，或者可能是患者病程中的一个促成因素。
