Читать книгу Practical Cardiovascular Medicine - Elias B. Hanna - Страница 43

A complex plaque, i.e., a ruptured unstable plaque, is identified angiographically by being ≥ 50% obstructive (generally), along with one or more of the following features:

1 Thrombus: round intraluminal filling defect or contrast stain, i.e., persistence of contrast over a focal area even after it clears from the rest of the vessel. An abrupt thrombotic vessel cutoff may be present.

2 Plaque ulceration: hazy, usually eccentric plaque with irregular or overhanging margins (Figure 1.9).¹²⁷

3 Impaired flow from distal microembolization.

Patients with NSTEMI frequently have multiple angiographically complex plaques (~40%). The culprit lesion is identified by seeking these morphological features but also by correlating with the ECG or imaging findings. In NSTEMI with multiple complex lesions, a clear single culprit may not be identified ~15-20% of the time, particularly given that the ST depression on the ECG is often not localizing.⁷⁹ Multivessel PCI of multiple obstructive stenoses is particularly justified in patients with multiple complex plaques and without one clear culprit.^80-83