Laurindo F R, Furlan A D, Jaeger R G, da Luz P L
Division of Experimental Research, University of São Paulo, Brazil.
Chest. 1993 Jan;103(1):273-8. doi: 10.1378/chest.103.1.273.
Although intracoronary thrombosis often occurs after angioplasty and may affect its outcome, the accuracy of arteriography for identification of mural thrombi is unclear. This study analyzed the relationship between arteriographic abnormalities immediately before death and the histologic extent of thrombosis in 77 dogs submitted to balloon injury of intact left anterior descending coronary arteries. Survival time after angioplasty was 120 min. The incidence of mural thrombosis, defined on serial histologic sections, was 65.0 percent. A positive diagnosis of intracoronary thrombus at arteriography (AT+) was based on the presence of any of the following signs: filling defects, retention of contrast material, and slowed or interrupted flow. Seventeen dogs were AT+, and 60 were AT-. The overall sensitivity of arteriography was 34 percent, and the specificity was 100 percent. Even considering as significant only thrombi greater than 25.0 percent of the arterial lumen area, 11 of 27 dogs were AT- despite thrombus sizes between 27 percent and 75 percent of lumen area (sensitivity, 59 percent); arteriography consistently missed smaller thrombi (22 of 23 dogs were AT-). Arterial diameters and balloon-induced injury were similar between AT- and AT+ dogs. Scanning electron microscopy depicted a fibrin-poor thrombus in 14 of 19 AT+ dogs and a fibrin-rich thrombus in five, whereas all seven AT+ dogs had fibrin-rich thrombi. Logistic regression analysis showed a correlation between thrombus size and arteriographic positivity, whereas the presence of fibrin and slowed flow of contrast material did not independently predict positive arteriographic results. Thus, arteriography is inaccurate for identification of mural thrombosis after angioplasty, mostly because of its poor sensitivity.
尽管冠状动脉内血栓形成常发生于血管成形术后并可能影响其预后，但血管造影术识别壁血栓的准确性尚不清楚。本研究分析了77只接受完整左前降支冠状动脉球囊损伤的犬死亡前即刻血管造影异常与血栓形成的组织学范围之间的关系。血管成形术后存活时间为120分钟。根据连续组织学切片定义的壁血栓形成发生率为65.0%。血管造影时冠状动脉内血栓阳性诊断（AT+）基于以下任何一种征象：充盈缺损、造影剂滞留以及血流缓慢或中断。17只犬为AT+，60只为AT-。血管造影术的总体敏感性为34%，特异性为100%。即使仅将大于动脉腔面积25.0%的血栓视为有意义，27只犬中有11只尽管血栓大小在管腔面积的27%至75%之间仍为AT-（敏感性为59%）；血管造影术始终漏诊较小的血栓（23只犬中有22只为AT-）。AT-和AT+犬之间的动脉直径和球囊诱导的损伤相似。扫描电子显微镜显示，19只AT+犬中有14只血栓纤维蛋白含量少，5只血栓纤维蛋白含量丰富，而所有7只AT-犬的血栓纤维蛋白含量均丰富。逻辑回归分析显示血栓大小与血管造影阳性之间存在相关性，而纤维蛋白的存在和造影剂血流缓慢并不能独立预测血管造影阳性结果。因此，血管造影术在识别血管成形术后壁血栓形成方面不准确，主要是因为其敏感性较差。
