Loire R, Tabib A, Pinede L
Hôpital cardiovasculaire et pneumologique Louis-Pradel, Lyon.
Arch Mal Coeur Vaiss. 1997 Oct;90(10):1385-90.
The anatomic lesions of two cases of sudden death (one man and one 24 years old woman) and of one case of rapidly fatal myocardial infarction (51 years old woman) are described. The coronary lesions were exclusively thrombotic with no associated atherosclerosis or pre-existing arterial wall change. The thrombi were occlusive from the outset or were constituted in successive mural stages, the last being occlusive and giving rise to the clinical symptoms (sudden death and/or myocardial infarction). Several points are discussed. The concept of normal coronary artery must be confirmed by anatomic examination: coronary angiography is not sufficient for the diagnosis of dangerous atherosclerotic plaques which are not particularly stenotic, eccentric, lipidic and fragile. Thrombogenic factors are better understood and some may play a role in these cases of "primary thrombosis", by they of plasma or platelet origin. The trigger role of spasm cannot be ignored as some of the spastic and thrombotic factors are similar. The preferential coronary site of these thromboses may be explained by constitutional changes (arterial hypolasia with narrow lumen) or acquired lesions (repeated arterial trauma due to shearing by the movements of the underlying left ventricle transmitted to the epicardial coronary arteries).
描述了两例猝死病例（一名男性和一名24岁女性）以及一例快速致死性心肌梗死病例（一名51岁女性）的解剖学病变情况。冠状动脉病变均为血栓形成，无相关动脉粥样硬化或先前存在的动脉壁改变。血栓从一开始就是闭塞性的，或者是在连续的壁内阶段形成，最后导致闭塞并引发临床症状（猝死和/或心肌梗死）。文中讨论了几个要点。正常冠状动脉的概念必须通过解剖学检查来证实：冠状动脉造影不足以诊断那些并非特别狭窄、偏心、富含脂质且脆弱的危险动脉粥样硬化斑块。对血栓形成因素有了更好的理解，其中一些因素可能在这些“原发性血栓形成”病例中起作用，这些因素源自血浆或血小板。痉挛的触发作用不可忽视，因为一些痉挛和血栓形成因素是相似的。这些血栓形成在冠状动脉的优先部位可能可以用先天性改变（管腔狭窄的动脉发育不全）或后天性病变（由于左心室运动传递至心外膜冠状动脉产生的剪切力导致的反复动脉损伤）来解释。
