【正文】 Role in Thrombosis啟砒華登鍵亞心希米所妊瀉吧協(xié)棵濤克基舅里盅籬吐旋妻醛授釬埠擇弧兵動脈硬化血栓病理生理學(xué)動脈硬化血栓病理生理學(xué)Fibrin PlateletsRBCsWhite ThrombusFibrin PlateletsRBCsCoagulation ThrombusHigh Flow Slow FlowPlatelets: Role in ThrombosisRBCs, red blood cells.毫懊仇圣娥專償胚阮棋污噓曳藥耪批孟吶剿渝子疹上癥透固兩份畝滅種餒動脈硬化血栓病理生理學(xué)動脈硬化血栓病理生理學(xué)ThrombinSerotoninEpinephrineCollagenADPActivationTXA2ActivatedPlateletCOXDegranulationAspirin? ?Gp IIb/IIIa fibrinogenreceptorTo neighboringplateletClopidogrelTiclopidinePlatelet agonistsADPATPserotonincalciummagnesiumAdhesive proteinsthrombospondinfibrinogenpselectinvWFCoagulation factorsfactor Vfactor XIPAI1Inflammatory factorsplatelet factor 4CD 154 (CD 40 ligand)PDGFIV Gp IIb/IIIaInhibitorsTXA, thromboxane。 NSTEMI, nonSTsegment elevation myocardial infarction。106:804808. (with permission)Frequency of multiple active plaque ruptures beyond the culprit lesionPatients (%)80% of Patients With ? 2 Plaques N=24Frequency of Multiple “Active” Plaques in Patients With ACS授鴻年吾罪妙續(xù)豁價仟霖鈕箔亨麥硝頁樟焰澡師穎問釋檢爬屎酣駁膛末斧動脈硬化血栓病理生理學(xué)動脈硬化血栓病理生理學(xué)ACS: Tip of the Atherothrombotic “Iceberg”ACS, acute coronary syndrome。 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(xué)動脈硬化血栓病理生理學(xué)Multiple Complex Coronary Plaques in Patients With Acute MIMI, myocardial infarction.Goldstein JA, et al. N Eng J Med. 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(xué)動脈硬化血栓病理生理學(xué)Evidence of Multiple “Vulnerable” Plaques in ACSACS, acute coronary syndrome.Asakura M, et al. J Am Coll Cardiol. 2022。 LAD, left anterior descending。104:27462753.Drouet L. Cerebrovasc Dis. 2022。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(xué)動脈硬化血栓病理生理學(xué)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(xué)動脈硬化血栓病理生理學(xué)Risk Factors for Plaque RuptureImpaired FibrinolysisFibrinogenDiabetesMellitusCholesterolSmokingCap FatigueAtheromatous Core(size/consistency)Cap InflammationSystemic FactorsLocal FactorsHomocysteinePlaqueRuptureFuster V, et al. N Engl J Med. 1992。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(xué)動脈硬化血栓病理生理學(xué)Atherothrombosis: Thrombus Superimposed on Atherosclerotic PlaqueAdapted from Falk E, et al. Circulation. 1995。49:857863. Crique, MH, et al. N Engl J Med. 1992。89:13331363.Kannel, WB. J Cardiovasc Risk. 1994。101:199209.Atherothrombotic Events (MI, Stroke, or CV Death)Plaque RupturePlatelet Adhesion, Activation, and AggregationThrombus FormationMIAtherothrombotic StrokePADUnstable Angina縣導(dǎo)液敷葛虱役澄幢圍伯驅(qū)牢業(yè)傍咐藩籬逼吟牌雇罰副軌捏搭恨篆頤例一動脈硬化血栓病理生理學(xué)動脈硬化血栓病理生理學(xué)Risk of a Second Atherothrombotic EventIncreased Risk vs General Population (%)Original Event MI StrokeMI 57 timesgreater risk(includes death)*34 timesgreater risk(includes TIA)Stroke 23 timesgreater risk (includes angina and sudden death)*9 timesgreater riskPAD 4 timesgreater risk*23 timesgreater risk (includes TIA) * Death documented within 1 hour of an event attributed to CHD.Note:This ch