[Complications after treatment of acute coronary syndrome].
The rupture of the unstable plaque and the thrombus formation caused the occlusion of the coronary artery and followed myocardial ischemia and/or myocardial necrosis, then resulted in clinical worse outcome. The reopen of the occluded artery is the most important things for the treatment of acute coronary syndrome, and there are usually two established ways to open the occluded artery. Thrombolysis and angioplasty are already established ways to reopen, however has some complications, that is, failure to reopen, reocclusion, and bleeding. Angioscopic observations reveal the mechanism underlying these complications and suggest that platelet rich white thrombus formation continues until a month after the onset and unstable yellow plaques exist until 18 months after the onset. The most problems for the treatment in today are the unaware of the mechanism of the occlusion. If the thrombus is the major mechanism for the occlusion, thrombolytic therapy must be chosen. If the plaque is the major occlusive mechanism, the angioplasty must be chosen. To reveal the mechanisms underlying the coronary artery occlusion, we will have to use the angioscope instead of coronary angiography. After we will be able to clarify the occlusive mechanism by angioscope, we will reduce the dosage of thrombolytic agents and resulted in the decrement of bleeding complications and reopen the coronary artery effectively without complications.
Kodama
K
K
Cardiovascular Division, Osaka Police Hospital.
Hirayama
A
A
D000208:Acute Disease; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D017546:Angioscopy; D002986:Clinical Trials as Topic; D003324:Coronary Artery Disease / Q000150:complications; D003327:Coronary Disease / Q000209:etiology / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D013577:Syndrome; D015912:Thrombolytic Therapy / Q000009:adverse effects*
D010975:Platelet Aggregation Inhibitors