Arakawa K, Etsuda H, Tabata H, Kurita A, Nakamura H, Mizuno K
First Department of Internal Medicine, National Defense Medical College, Tokorozawa.
J Cardiol. 1995 Jul;26(1):39-42.
A 45-year-old man was admitted with the diagnosis of acute inferior myocardial infarction. After successful thrombolytic therapy, coronary angiography showed TIMI grade 3 flow with the filling defect and haziness on the infarct-related coronary segment. Repeat coronary angiography and coronary angioscopy were performed on the 28th hospital day. Coronary angiography showed 50% stenosis of the luminal diameter of the right coronary artery. Coronary angioscopy showed a white plaque with ruptured cap which occupied one third of the circumferential coronary artery. The torn ends of the cap were longitudinal, and projected into the lumen during the cardiac cycle. Plaque rupture and thrombus formation are important in the pathogenesis of acute coronary syndromes, although the mechanism of plaque rupture is still controversial. The present angioscopic findings seem to support the concept that circumferential tension or mechanical stretch from part of the coronary artery causes the longitudinal fissure at the weakened site of the plaque cap.
一名45岁男性因急性下壁心肌梗死入院。溶栓治疗成功后，冠状动脉造影显示梗死相关冠状动脉节段TIMI 3级血流伴充盈缺损和模糊影。在住院第28天进行了重复冠状动脉造影和冠状动脉血管内镜检查。冠状动脉造影显示右冠状动脉管腔直径狭窄50%。冠状动脉血管内镜检查显示一个白色斑块，其帽状物破裂，占据冠状动脉圆周的三分之一。帽状物的撕裂端呈纵向，在心动周期中突入管腔。斑块破裂和血栓形成在急性冠状动脉综合征的发病机制中很重要，尽管斑块破裂的机制仍存在争议。目前的血管内镜检查结果似乎支持这样一种观点，即冠状动脉部分的圆周张力或机械拉伸会导致斑块帽薄弱部位出现纵向裂缝。
