冠状动脉血栓机化病变——“藕孔状”或“蜂窝状”表现的影像特点及介入治疗

The Characteristic of Coronary Angiography and the Techniques of Percutaneous Coronary Intervention of the Honeycomb-like or Lotus Root-like Organized Thrombi Lesions in Coronary Arteries

目的 探讨冠状动脉血栓呈“蜂窝状”或“藕孔状”机化患者的临床表现与冠状动脉造影表现的特点、介入治疗的方法与作用。方法 回顾性分析10例冠状动脉造影呈现“蜂窝状”或“藕孔状”征象的血栓机化病变并进行了介入治疗的病例。结果 10例患者中7例有明确的该类病变冠状动脉支配区域的心肌梗死病史，心肌梗死的发病时间均在1个月以上（1月～20年）；3例无明确的心肌梗死病史。“蜂窝状”或“藕孔状”病变发生于右冠状动脉7例（7/10，70.0%），前降支3例（3/10，30.0%）。10例中8例有心肌缺血依据的患者进行了介入治疗，成功7例（成功率87.5%）。7例介入治疗成功的患者，最终通过的导丝依次是Runthrough（3例），Fielder XT（2例），Fielder（1例），Pilot 150（1例）。结论 冠状动脉内呈“蜂窝状”或“藕孔状”表现的血栓机化病变多发生于右冠状动脉。其介入治疗主要依靠导丝采用滑（sliding）的技术通过病变中的微孔道，应首选亲水导丝。

Aim To summarize the clinical manifestation and the characteristic of coronary angiography of patients with the honeycomb-like or lotus root-like coronary thrombotic lesions, and to explore the experiences and technique of percutaneous coronary intervention （PCI） for the peculiar coronary lesions. Methods We retrospectively analyzed the data from 10 patients with the honeycomb-like or lotus root-like coronary thrombotic lesions. Results 7 of 10 patients with the honeycomb-like or lotus root-like coronary thrombotic lesions suffered from myocardial infarction more than one month（one month～20 years）. The honeycomb-like or lotus root-like coronary thrombotic lesions were found in right coronary arteries in 7 of 10 patients, and in left anterior descending coronary artery in the other 3 patients. Successful PCI was performed in 7 of 8 patients with the evidence of myocardial ischemia. Conclusion The honeycomb-like or lotus root-like coronary lesions resulting from recanalized thrombus after myocardial infarction are common in right coronary artery. The hydrophilic-guide wires are often the preferred choice of PCI for the peculiar coronary thrombotic lesions.