急性心筋梗塞における冠動脈血栓の病理学的検討

Pathological Analysis of Intracoronary Thrombus in Acute Myocardial Infarction

要旨　【目的】心筋梗塞の急性期病態における冠動脈血栓の病理学的検討を血栓除去用カテーテル標本を用いて行った．【対象と方法】緊急冠動脈造影を施行し，冠動脈血栓による閉塞または亜閉塞を認めた急性心筋梗塞患者50症例に対して血栓除去用カテーテルを用いて冠動脈内血栓を吸引した．【結果】36例から0.5〜40mmの冠動脈血栓を採取した．全例に血小板，フィブリン，好中球を認め，28例は血小板を主体とする血小板血栓であった．5例は赤血球を主体とし，3例は赤血球と血小板が混在する血栓であった．13例は動脈硬化成分（コレステリン，泡沫細胞，膠原線維）を認めた．【結語】急性心筋梗塞発症初期の冠動脈血栓は血小板が主体であり，一部にプラークが破綻した際に血栓内にとらえられた動脈硬化細胞を認めた．急性心筋梗塞の治療と予防には抗血小板療法が重要であることを支持する結果と思われた．

　Objectives : We pathologically analyzed the collected intracoronary thrombus in early phase of the acute myocardial infarction (AMI) patients using thrombectomy catheter samples. Method : We suctioned intracoronary thrombus using the thrombectomy catheter to 50 AMI patients, accompanied by occluded or sub-occluded lesions by thrombus angiographically. Results : Thrombus with 0.5-40mm in length was gathered in 36 patients. Blood platelet, fibrin and neutrophil were found in all cases, and blood platelet thrombi were mainly contained in 28 cases. Red blood cells in 5cases, and the mixed thrombus with white and red blood cells in 3 cases. Atherosclerosis components such as cholesterin, foam cells, and collagen were found in 13 cases. Conclusion : In the early phase of AMI, intracoronary thrombus mainly consisted in blood platelets. Atherosclerosis components combined with thrombus by plaque rupture were also partially contained. The pathological analysis suggests that anti-platelet therapy will be required to prevent and treat acute myocardial infarctions.