According to the mechanism and site of occurrence, the author classifies thromboembolic diseases into atherothrombosis, arterial embolism, and venous thromboembolism (VTE). VTE). Among them, atherothrombosis is the first cause of mortality and morbidity; venous thromboembolism includes pulmonary embolism and deep vein thrombosis, which is the third cause of death in western countries; arterial embolic diseases include cardiogenic, vascular and paradoxical embolism, whose incidence, mortality and disability are far beyond our attention in the real world. of attention, such as cerebral and peripheral arterial embolism due to atrial fibrillation.
Atherosclerotic thrombosis is the rupture of an unstable atherosclerotic plaque on the basis of which platelet-rich thrombi are formed, leading to vascular events and even vascular death. The process of
I. Pathophysiology of atherosclerotic thrombosis and its clinical manifestations
Atherosclerosis is a series of pathophysiological processes. Early lesions of atherosclerosis can appear in preschool children, namely, lipid streaks, which gradually form plaques with age and the action of risk factors, and the plaques become larger and larger, and there can be no clinical manifestations in the early stage. If the plaque is unstable and rupture occurs, a thrombus will be formed on the basis of the rupture, leading to acute vascular events such as cerebral infarction and myocardial infarction, and even vascular death.
Atherosclerosis is a systemic disease, and the occurrence of atherosclerotic lesions in one vascular bed means that the same lesions may already exist in other vessels; similarly, the occurrence of vascular events (vascular events) in one vessel means an increased risk of vascular events in other vascular beds, and indeed peripheral arterial disease is predominantly fatal due to coronary events (55%). Of the patients enrolled in the CAPRIE study who had developed atherosclerotic lesions, 29.9%, 24.7%, and 19.2% had coronary artery alone, cerebral artery alone, and peripheral artery alone, respectively, while the remaining 26.2% had a combination of two or even three vascular lesions.
According to the clinical manifestations, atherosclerotic thrombosis can be divided into two main categories, one is stable and the other is unstable (Table 1).
Table 1 Classification of atherosclerotic thrombosis
Atherosclerotic thrombosis
Stable
Unstable
Cerebral artery
Chronic ischemic encephalopathy, vascular dementia
Acute ischemic stroke, including cerebral infarction and TIA
Coronary artery
Asymptomatic or stable angina pectoris
Acute coronary syndromes, including both ST-segment elevation and ST non-elevation
Peripheral arteries
Intermittent claudication
Rest pain, acute ischemia and necrosis of the limb, amputation, etc.
Unstable plaque