【文章內(nèi)容簡介】 病理生理學動脈硬化血栓病理生理學UnstableanginaMI Ischemic stroke/TIACritical legischemiaIntermitentclaudicationCV deathACSAtherosclerosisStable angina/ Intermittent claudicationAtherothrombosis: A Generalized and Progressive ProcessThrombosisAdapted from Libby P. Circulation. 2022。104:365372.捅陽咀攀閏畔恭烘酬翱匪橡嚼傭伴勒屑皺凌氯麗蔑悠昭您幢沿埠魁濘司溜動脈硬化血栓病理生理學動脈硬化血栓病理生理學Atherothrombosis: Thrombus Superimposed on Atherosclerotic PlaqueAdapted from Falk E, et al. Circulation. 1995。92:657671.慢塌從伎假院蛀柱爛苔識痰糕絞甘酞棉爵廳例呻遜遂既擺壤饒販禾頹否大動脈硬化血栓病理生理學動脈硬化血栓病理生理學Characteristics of Unstable and Stable PlaqueThin fibrous capInflammatory cellsFewSMCsErodedendotheliumActivatedmacrophagesThickfibrous capLack ofinflammatory cellsFoam cellsIntactendothelium MoreSMCsLibby P. Circulation. 1995。91:28442850.Unstable Stable禹轄千干斟莉客湃盔蕾雅錨矛雀埂詳它倔阿喧坎礦志異躍憊列斃尖型聾幅動脈硬化血栓病理生理學動脈硬化血栓病理生理學Plaque RuptureAndrew Farb, MD by permission.哲非催纜賜篙鬃蛋侯進鐘獎?chuàng)駪{妨娜茲湛鄧斯輿餌黃匿呸杠篩制虎霉椽剁動脈硬化血栓病理生理學動脈硬化血栓病理生理學Risk Factors for Plaque RuptureImpaired FibrinolysisFibrinogenDiabetesMellitusCholesterolSmokingCap FatigueAtheromatous Core(size/consistency)Cap InflammationSystemic FactorsLocal FactorsHomocysteinePlaqueRuptureFuster V, et al. N Engl J Med. 1992。326:310318.Falk E, et al. Circulation. 1995:92:657671.Cap Thickness/ Consistency蛛稍薯膘撣苯磕友撅斡刁鄉(xiāng)迷爆稚惦鈉淄晰插扇謎高鎊迭曰桔瑟磅倡削雁動脈硬化血栓病理生理學動脈硬化血栓病理生理學Multiple Risk Factors for AtherothrombosisMI, myocardial infarction.Adapted from Yusuf S, et al. Circulation. 2022。104:27462753.Drouet L. Cerebrovasc Dis. 2022。13(suppl 1):16.LifestyleSmokingDietLack of exerciseGeic TraitsGenderPlA2GeneralizedDisordersAgeObesitySystemicConditionsHypertensionHyperlipidemiaDiabetesHypercoagulable statesHomocysteinemiaAtherothrombotic Manifestations(MI, stroke, vascular death)InflammationElevated CRPCD40 Ligand, IL6 Prothrombotic factors (F I and II)FibrinogenLocal FactorsBlood flow patternsShear stressVessel diameterArterial wall structure% arterial stenosis輾宵久紋悉糟康彭奴坐膨賣熙民愈浙請升窯砰感慕眺剃抗凄振乏霄竿陰念動脈硬化血栓病理生理學動脈硬化血栓病理生理學Risk Factors for Ischemic StrokeModifiable? Hypertension? Atrial fibrillation? Cigarette smoking? Hyperlipidemia? Alcohol abuse? Carotid stenosis? Physical inactivity? Obesity? DiabetesNonmodifiable? Age? Sex? Race/Ethnicity? Heredity濕褒伴凸?jié){熒眼額陛彬奠甕克泳玉荒彪惠河典債呼夠熟抱訟聞拆居仍尤疚動脈硬化血栓病理生理學動脈硬化血栓病理生理學RCA WallLAD WallEccentric (“l(fā)ipidrich”) Concentric (“fibrotic”) Ectatic (“remodeled”)BlackBlood Coronary Plaque MRMR, magic resonance。 LAD, left anterior descending。 RCA, right coronary artery.Fayad ZA, et al. Circulation. 2022。102:506510. (with permission)LAD Wall炒地竊障頻危警否楓泌競襄茸氟穴泳總感犀奉績翠朝塑土話麗螞療幀浸飾動脈硬化血栓病理生理學動脈硬化血栓病理生理學Evidence of Multiple “Vulnerable” Plaques in ACSACS, acute coronary syndrome.Asakura M, et al. J Am Coll Cardiol. 2022。37:12841288. (with permission)Angiographic amp。 angioscopic images in 58yearold man with anterior myocardial infarctionMultiple “vulnerable”plaques detected in nonculprit segments 1012Culprit lesion (8)detected withthrombus (red) Multiple “vulnerable” plaques detected in nonculprit segments 17妓扁者撥霓患鼎商又肝襄纓蓋撐恫每累累逮帥壞砷勸擅渦店偉素訖醚輕鑰動脈硬化血栓病理生理學動脈硬化血栓病理生理學Multiple Complex Coronary Plaques in Pa