Saber R S, Edwards W D, Bailey K R, McGovern T W, Schwartz R S, Holmes D R
Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota 55905.
J Am Coll Cardiol. 1993 Nov 1;22(5):1283-8. doi: 10.1016/0735-1097(93)90531-5.
This study was undertaken to examine the nature, extent and clinical relevance of coronary embolism after balloon angioplasty or thrombolytic therapy, or both.
Histopathologic documentation of postinterventional coronary embolization has been reported in only 10 patients from five studies.
This retrospective autopsy-based study included 32 patients, treated with balloon angioplasty or thrombolysis, or both, who died within 3 weeks of the procedure and underwent autopsy at the Mayo Clinic. Clinical variables included patient age and gender, artery treated, site and type of obstruction, type of intervention, success of the procedure, and postprocedural changes in the electrocardiogram (ECG), cardiac enzymes and hemodynamic status. Histopathologic variables included characteristics of treated plaques, acutely infarcted myocardium and coronary microemboli. Associations between microemboli and clinical and microscopic factors were evaluated by t tests and simple and multiple linear regression.
Emboli were observed in 26 (81%) of the 32 patients. Among 83 emboli, 95% were thrombotic or atheromatous. The presence of microemboli was associated statistically with the development of postprocedural infarct extension, new myocardial infarction or new ECG abnormalities. Moreover, the greatest number of microemboli were associated with intervention in the left anterior descending coronary artery, multiple interventional sites, postprocedural medial dissection and plaque rupture or extrusion.
Among patients undergoing balloon angioplasty or thrombolytic therapy who die and undergo autopsy, coronary microemboli occur in a substantial percent. The frequency in survivors is unknown. However, in living patients who develop acute myocardial ischemia or new ECG abnormalities after these interventions, coronary microembolization should be considered a potential cause.
本研究旨在探讨球囊血管成形术或溶栓治疗或两者兼施后冠状动脉栓塞的性质、范围及临床相关性。
仅在五项研究中的10例患者中报道了介入治疗后冠状动脉栓塞的组织病理学证据。
这项基于尸检的回顾性研究纳入了32例接受球囊血管成形术或溶栓治疗或两者兼施的患者，这些患者在手术后3周内死亡并在梅奥诊所接受了尸检。临床变量包括患者年龄和性别、治疗的动脉、阻塞部位和类型、干预类型、手术成功率以及术后心电图（ECG）、心肌酶和血流动力学状态的变化。组织病理学变量包括治疗斑块的特征、急性梗死心肌和冠状动脉微栓子。通过t检验以及简单和多元线性回归评估微栓子与临床和微观因素之间的关联。
32例患者中有26例（81%）观察到栓子。在83个栓子中，95%为血栓性或动脉粥样硬化性。微栓子的存在与术后梗死扩展、新发心肌梗死或新的心电图异常的发生在统计学上相关。此外，微栓子数量最多与左前降支冠状动脉介入治疗、多个介入部位、术后中层剥离以及斑块破裂或挤出有关。
在接受球囊血管成形术或溶栓治疗后死亡并接受尸检的患者中，相当一部分会发生冠状动脉微栓子。幸存者中的发生率尚不清楚。然而，在这些干预后出现急性心肌缺血或新的心电图异常的存活患者中，应考虑冠状动脉微栓塞是一个潜在原因。
