PDF(Pubmed)
Abstract：
UNASSIGNED: Healed plaque, characterized by distinct layers of organizing thrombus and collagen, is the hallmark of tissue self-repair. However, the efficacy of excimer laser coronary angioplasty (ELCA) followed by drug-coated balloon (DCB) angioplasty in patients with healed plaques is not fully understood.
UNASSIGNED: A 42-year-old woman with a history of anxiety disorder was admitted to our institution with worsening chest pain and subsequently diagnosed with anterior non-ST-elevation myocardial infarction. Coronary angiography revealed severe stenosis in the proximal left anterior descending artery (LAD) despite Thrombolysis in Myocardial Infarction (TIMI) grade 3. Optical coherence tomography (OCT) showed healed plaques with partial macrophage accumulation and no fresh thrombus. Plaque disruption and thin-cap fibrous atheroma were not identified in the culprit lesions. Intravascular ultrasound (IVUS) confirmed high-intensity marginal irregular masses at the culprit site, suggesting that the thrombus was formed by plaque erosion rather than lipid plaque or necrotic tissue. With lesion modification using ELCA prior to DCB angioplasty, OCT examination of the LAD after ELCA showed a significant reduction in plaque burden and preserved lumen size. Post-percutaneous coronary intervention angiography revealed no stenosis with TIMI grade 3. A follow-up coronary computed tomography scan showed no angiographic restenosis, and the patient remained symptom-free.
UNASSIGNED: Here we describe a case in which OCT and IVUS evaluation suggested organizing thrombus due to erosion healing, and a favorable outcome was achieved with the combination of ELCA and DCB. The combination use of ELCA and DCB might be a potential strategy for acute coronary syndrome patients with organizing thrombus.
UNASSIGNED: A 42-year-old woman with a history of anxiety disorder was admitted to our institution with worsening chest pain and subsequently diagnosed with anterior non-ST-elevation myocardial infarction. Coronary angiography revealed severe stenosis in the proximal left anterior descending artery (LAD) despite Thrombolysis in Myocardial Infarction (TIMI) grade 3. Optical coherence tomography (OCT) showed healed plaques with partial macrophage accumulation and no fresh thrombus. Plaque disruption and thin-cap fibrous atheroma were not identified in the culprit lesions. Intravascular ultrasound (IVUS) confirmed high-intensity marginal irregular masses at the culprit site, suggesting that the thrombus was formed by plaque erosion rather than lipid plaque or necrotic tissue. With lesion modification using ELCA prior to DCB angioplasty, OCT examination of the LAD after ELCA showed a significant reduction in plaque burden and preserved lumen size. Post-percutaneous coronary intervention angiography revealed no stenosis with TIMI grade 3. A follow-up coronary computed tomography scan showed no angiographic restenosis, and the patient remained symptom-free.
UNASSIGNED: Here we describe a case in which OCT and IVUS evaluation suggested organizing thrombus due to erosion healing, and a favorable outcome was achieved with the combination of ELCA and DCB. The combination use of ELCA and DCB might be a potential strategy for acute coronary syndrome patients with organizing thrombus.
摘要：
■治疗牌匾，以组织血栓和胶原蛋白的不同层为特征，是组织自我修复的标志.然而,对于斑块愈合的患者,准分子激光冠状动脉成形术(ELCA)后再进行药物涂层球囊(DCB)血管成形术的疗效尚不完全清楚.
■一名42岁有焦虑症病史的女性因胸痛加重入院，随后被诊断为前部非ST段抬高型心肌梗死。尽管在心肌梗死（TIMI）3级进行了溶栓治疗，但冠状动脉造影显示左前降支（LAD）近端严重狭窄。光学相干断层扫描（OCT）显示斑块愈合，部分巨噬细胞积聚，无新鲜血栓。在罪魁祸首病变中未发现斑块破裂和薄帽纤维动脉粥样硬化。血管内超声（IVUS）证实了罪魁祸首部位的高强度边缘不规则肿块，提示血栓是由斑块侵蚀而不是脂质斑块或坏死组织形成的。在DCB血管成形术之前使用ELCA进行病变修饰，ELCA后LAD的OCT检查显示斑块负荷显著减少，管腔大小得以保留。经皮冠状动脉介入治疗后血管造影显示TIMI3级无狭窄。随访冠状动脉计算机断层扫描显示无血管造影再狭窄,患者保持无症状。
■在这里，我们描述了一个病例，其中OCT和IVUS评估建议由于侵蚀愈合而形成血栓，ELCA和DCB的组合取得了良好的结果。联合使用ELCA和DCB可能是急性冠状动脉综合征合并血栓形成的潜在策略。
■一名42岁有焦虑症病史的女性因胸痛加重入院，随后被诊断为前部非ST段抬高型心肌梗死。尽管在心肌梗死（TIMI）3级进行了溶栓治疗，但冠状动脉造影显示左前降支（LAD）近端严重狭窄。光学相干断层扫描（OCT）显示斑块愈合，部分巨噬细胞积聚，无新鲜血栓。在罪魁祸首病变中未发现斑块破裂和薄帽纤维动脉粥样硬化。血管内超声（IVUS）证实了罪魁祸首部位的高强度边缘不规则肿块，提示血栓是由斑块侵蚀而不是脂质斑块或坏死组织形成的。在DCB血管成形术之前使用ELCA进行病变修饰，ELCA后LAD的OCT检查显示斑块负荷显著减少，管腔大小得以保留。经皮冠状动脉介入治疗后血管造影显示TIMI3级无狭窄。随访冠状动脉计算机断层扫描显示无血管造影再狭窄,患者保持无症状。
■在这里，我们描述了一个病例，其中OCT和IVUS评估建议由于侵蚀愈合而形成血栓，ELCA和DCB的组合取得了良好的结果。联合使用ELCA和DCB可能是急性冠状动脉综合征合并血栓形成的潜在策略。
