Causation and Prevention of Coronary Thrombosis : Present Situation
Most coronary thrombi large enough to be detected by angiography are associated with tears or fissures in the caps of atherosclerotic plaques. These fissures allow blood to penetrate into the arterial wall, whereupon thrombus forms within the intima; this may be followed by thrombosis in the lumen. This process was first described in 1926 (Benson, 1926; Constantinides, 1966); however, its pre-eminence in initiating acute clinical events was realized more recently after the microanatomy of coronary thrombi was established by serial histological sectioning (Fulton,1965; Davies and Thomas, 1981, 1985). Knowledge of post-mortem angiographic appearance of plaque fissures allowed them to be recognized in the angiograms of living patients with unstable angina (Ambrose, 1985, 1988; Lo et al., 1988) or with acute myocardial infarction, (Ambrose et al., 1985, 1986) and in patients resuscitated from sudden ischemic death. Angioscopy in living patients with unstable angina has also confirmed the presence of mural thrombi on torn atherosclerotic plaques in the coronary arteries (Sherman et al., 1986; Forrester et al., 1987).
KeywordsUnstable Angina Coronary Thrombosis Circumferential Stress Lipid Pool Coronary Thrombus
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