Main Article Content
Abstract
RÉSUMÉ
Le syndrome coronaire aigu est une cause importante de morbi-mortalité à travers le monde. Sa prise en charge rapide par les avancées techniques et pharmacologiques a permis de réduire sa mortalité dans les pays développés. Les mécanismes principaux à l’origine du syndrome coronaire aigu sont la rupture ou l’érosion de plaque d’athérosclérose. L’érosion de plaque correspond à une altération de l’endothélium sans atteinte intimale aboutissant à la formation rapide de thrombus en quelques secondes puis de thrombose artérielle brutale. Son terrain de prédilection concerne les sujets jeunes de sexe masculins et tabagique. Elle est évoquée devant une charge thrombotique élevée à l’angiographie et confirmée par l’imagerie endocoronaire en particulier la tomographie par cohérence optique. Le traitement des syndromes coronaires aigus par érosion de plaque est conservateur et basé sur les anti-thrombotiques. Dans cet article, nous présentons le cas d’un syndrome coronaire aigu par érosion de plaque d’évolution favorable.
ABSTRACT
Acute coronary syndrome is a major cause of morbidity and mortality worldwide. Its rapid management by technical and pharmacological advances has made it possible to reduce its mortality in developed countries. The main mechanisms behind acute coronary syndrome are rupture or erosion of atherosclerotic plaque. Erosion of plaque corresponds to an alteration of the endothelium without intimal involvement leading to the rapid formation of thrombus in a few seconds then of brutal arterial thrombosis. It mainly affects young male and smoking subjects. The diagnosis is evoked in front of a high thrombotic load at angiography and confirmed by endocoronary imaging, usually optical coherence tomography. The treatment of acute coronary syndromes by plaque erosion is conservative, based on anti-thrombotics. We report a typical case of acute coronary syndrome due to plaque erosion whose outcome was favorable.
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References
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References
-Fox KAA, Steg PG, Eagle KA, Goodmann SG, Anderson FA, Granger CB, et al. Decline in rates of death and heart failure in acute coronary syndromes, 1999-2006. JAMA 2007 ; 297 (17) : 1892-900
-French register on acute ST-elevation and non-ST-elevation myocardial infarction 2015 (FATMI 2015). Design and baseline data-PubMed– NCBI (Internet ; cité 27 août 2017 ; disponible : https//www-ncbi-nlm-gov.gate2.inist.fr/pub Med/28647465).
- Virmani R, Burke AP, Farb A, Kolodgie FD.
Pathology of the vulnerabe plaque. J Am Coll. Cardiol 2006 ; 47(8 suppl.) :C13-8
- Noc M, Fajadet j, lassen JF, Kala P, MacCarthy P, Olivecrona Gk, et al. Invasive coronary treatment strategies for out-of-hospital cardiac arrest : a consensus statement from European Association for Percutaneous Cardiovascular Interventions (EAPCI)/Stent for Live (SFL) groups. Euro Intervention 2014 ; 10(1) :31-7
- Jia H, Dai J, Hou J, Xing L, Ma L, Liu H, et al. Effective anti-thrombotic therapy without stenting : intravascular Optical coherence tomography-based management in plaque erosion (the EROSION study). Eur Heart J 2017 ;38(11) :792-800
- Combaret N, Souteyrand G, Barber-Chamoux N, Malcles G, Amonchot A, Pereira B, et al. Management of ST-elevation myocardial infarction in young patients by limiting implantation of durable intracoronary devices and guided by optical frequency domain imaging proof of concept study. Euro Intervention 2017 ;13(4) :397-406
- Mester P, Bouvaist H, Delarche N, Bouisset F, Abdellaoui M, Petiteau PY, et al. At least seven days delayed stenting using minimalist immediate mechanical intervention (MIMI) in ST-segment elevation myocardial infarction : the SUPER-MIMI study. EuroIntervention 2017 ;13(4) :390-6