Silva J A, White C J, Collins T J, Ramee S R
Department of Internal Medicine, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, LA 70121, USA.
Am Heart J. 1998 Jul;136(1):156-63. doi: 10.1016/s0002-8703(98)70196-6.
Coronary vein grafts develop accelerated atherosclerosis after aortocoronary bypass surgery. Previous pathologic studies have suggested that the morphologic appearance of atherosclerotic lesions in saphenous vein grafts may have subtle differences compared with those of native coronary arteries and may be more prone to disruption and thrombus formation. However, a comparative in vivo assessment of the angioscopic morphology differences between these two types of vessels has not been reported previously. We compared the angioscopic lesion morphology of native coronary arteries and saphenous vein grafts in patients with unstable angina.
Percutaneous coronary angioscopy was performed in 60 consecutive patients with unstable angina. Plaque color, texture, friability, and the presence of atherosclerotic plaque ulceration or intracoronary thrombus were noted in the culprit lesion. The culprit lesion was located in native coronary arteries in 42 (70%) patients and in a saphenous vein graft in 18 (30%) patients. There were no significant differences in age, sex, and coronary risk factors including tobacco use, hypertension, hypercholesterolemia, or diabetes mellitus between the two populations. There were also no significant differences between the two groups in terms of plaque color, surface texture, or the incidence of complex plaque morphology (plaque ulceration and intracoronary thrombosis). Loosely adherent, friable plaque, detected by angioscopy, was absent in native coronary arteries and was present in 44% of the saphenous vein grafts (p < 0.0001).
The results of our angioscopic study indicate that other than a high incidence of plaque friability in vein grafts, the surface morphology of culprit lesions in unstable angina patients is quite similar for saphenous vein grafts and native coronary arteries.
冠状动脉旁路移植术后，冠状动脉静脉移植物会出现动脉粥样硬化加速进展的情况。既往病理研究表明，与天然冠状动脉相比，大隐静脉移植物中动脉粥样硬化病变的形态学表现可能存在细微差异，且更易发生破裂和血栓形成。然而，此前尚未有关于这两种血管在体内血管镜形态学差异的比较评估报道。我们比较了不稳定型心绞痛患者天然冠状动脉和大隐静脉移植物的血管镜下病变形态。
对60例连续的不稳定型心绞痛患者进行了经皮冠状动脉血管镜检查。记录罪犯病变处斑块的颜色、质地、易碎性以及动脉粥样硬化斑块溃疡或冠状动脉内血栓的存在情况。42例（70%）患者的罪犯病变位于天然冠状动脉，18例（30%）患者的罪犯病变位于大隐静脉移植物。两组在年龄、性别以及包括吸烟、高血压、高胆固醇血症或糖尿病在内的冠状动脉危险因素方面无显著差异。两组在斑块颜色、表面质地或复杂斑块形态（斑块溃疡和冠状动脉内血栓形成）的发生率方面也无显著差异。血管镜检查发现，天然冠状动脉中不存在松散附着、易碎的斑块，而大隐静脉移植物中有44%存在此类斑块（p < 0.0001）。
我们的血管镜研究结果表明，除了静脉移植物中斑块易碎性发生率较高外，不稳定型心绞痛患者罪犯病变在大隐静脉移植物和天然冠状动脉中的表面形态相当相似。
