Comparison of Coronary Arterial Finding by Intravascular Ultrasound in Patients With “Transient No-Reflow” Versus “Reflow” During Percutaneous Coronary Intervention in Acute Coronary Syndrome

Iijima, Raisuke; Shinji, Hideo; Ikeda, Nobutaka; Itaya, Hideki; Makino, Kunihiko; Funatsu, Atsushi; Yokouchi, Itaru; Komatsu, Hirotaka; Ito, Naoki; Nuruki, Hiroya; Nakajima, Rintaro; Nakamura, Masato

doi:10.1016/j.amjcard.2005.07.104

Cited by 79 publications

(53 citation statements)

References 12 publications

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“…[5][6][7][8] Indeed, our current results showed that the culprit lesions of patients with the no-reflow phenomenon tended to have a larger plaque burden and a larger RI than those in patients without the no-reflow phenomenon, although the differences were not statistically significant. In addition, our spectral analysis of IVUS RF data demonstrated that plaque composition was an important factor in the occurrence of the no-reflow phenomenon.…”

Section: Discussioncontrasting

confidence: 38%

“…Previous studies have demonstrated that a large plaque burden, positive remodeling, and lipid pool-like images increase the risk for the no-reflow phenomenon. [5][6][7][8][9] However, the detailed differences in the plaque composition between patients with and without the no-reflow phenomenon have been difficult to assess with gray-scale IVUS.Recently, spectral analysis of IVUS radiofrequency (RF) data has been shown to provide detailed quantitative and Circulation Journal Vol.72, August 2008 qualitative information on the composition of coronary plaques in vivo. 10-14 A study by Nasu et al found that in vivo characterization of coronary plaques by 'virtual histology' (VH) correlated favorably with the results of in vitro histopathological examination of tissue samples obtained by directional coronary atherectomy.…”

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confidence: 99%

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Impact of Culprit Plaque Composition on the No-Reflow Phenomenon in Patients With Acute Coronary Syndrome An Intravascular Ultrasound Radiofrequency Analysis

Higashikuni

Tanabe

Tanimoto

et al. 2008

Circ J

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ercutaneous coronary intervention (PCI) is the most common and effective strategy for treating acute coronary syndrome (ACS), but it is not always successful, mainly because of the no-reflow phenomenon, 1,2 which is associated with poor functional and clinical outcomes, even when Thrombolysis In Myocardial Infarction (TIMI) flow of grade 3 is acquired at the end of the procedure. [2][3][4] To elucidate the mechanisms underlying the no-reflow phenomenon and to predict its occurrence, differences in the culprit plaque morphology in patients with and without the no-reflow phenomenon have been investigated by grayscale intravascular ultrasound (IVUS) studies. Previous studies have demonstrated that a large plaque burden, positive remodeling, and lipid pool-like images increase the risk for the no-reflow phenomenon. [5][6][7][8][9] However, the detailed differences in the plaque composition between patients with and without the no-reflow phenomenon have been difficult to assess with gray-scale IVUS.Recently, spectral analysis of IVUS radiofrequency (RF) data has been shown to provide detailed quantitative and Circulation Journal Vol.72, August 2008 qualitative information on the composition of coronary plaques in vivo. 10-14 A study by Nasu et al found that in vivo characterization of coronary plaques by 'virtual histology' (VH) correlated favorably with the results of in vitro histopathological examination of tissue samples obtained by directional coronary atherectomy. 15 In the present study, we used VH to assess the differences in culprit plaque composition between ACS patients with and without the no-reflow phenomenon. Methods Patients and LesionsBetween June 2005 and April 2006, 103 consecutive individuals were admitted with ACS. They had either acute myocardial infarction within 24 h of onset or unstable angina of Braunwald's class IIIB (angina at rest without increased creatine kinase (CK)-MB activity within 24 h before coronary angiography). For these patients, coronary angiography was performed to identify culprit lesions, and then PCI was carried out. If thrombi were angiographically detected, percutaneous aspiration thrombectomy with TVAC™ (Nipro Corporation, Osaka, Japan) was performed to minimize the influence of thrombi on subsequent IVUS examinations, 16 which were carried out to assess the morphology of the culprit plaques. If a mobile mass with homogenous echo density, suggestive of thrombus, was also found on IVUS examination, percutaneous aspiration thrombectomy was repeated until the mass was not detected on IVUS examination. However, IVUS examination was not attempted Hiroyoshi Nakajima, MD; Kazuhiro Hara, MD Background The difference in the culprit plaque composition of acute coronary syndrome (ACS) patients with and without the no-reflow phenomenon has not been fully evaluated. Methods and ResultsIntravascular ultrasound radiofrequency data of culprit plaques were obtained and analyzed in 49 ACS patients. The no-reflow phenomenon was defined as a decrease of at least 1 grade in 'Thrombolysi...

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Section: Discussioncontrasting

confidence: 38%

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confidence: 99%

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Impact of Culprit Plaque Composition on the No-Reflow Phenomenon in Patients With Acute Coronary Syndrome An Intravascular Ultrasound Radiofrequency Analysis

Higashikuni

Tanabe

Tanimoto

et al. 2008

Circ J

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“…TA reduced the rates of predilatation 23,24 and postdilatation, 25,26 which are usually associated with no-reflow phenomenon and poor prognosis after a STEMI. Manual TA also allowed implantation of bigger and fewer stents.…”

Section: Optimization In Angiographic Results and Stent Implantationmentioning

confidence: 99%

Optimization in Stent Implantation by Manual Thrombus Aspiration in ST-Segment–Elevation Myocardial Infarction

Fernández-Rodríguez

Regueiro

Brugaletta

et al. 2014

Circ: Cardiovascular Interventions

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Background-Manual thrombus aspiration (TA) is effective to reduce the thrombus burden during primary percutaneous coronary intervention for ST-elevation myocardial infarction. The objective of this study is to assess the impact of manual TA on stent implantation during primary percutaneous coronary intervention. Methods and Results-Population of the EXAMINATION trial (n=1498) was divided into 2 groups according to the use of TA. Immediate angiographic results, primary patient-oriented end point (combination of all-cause death, myocardial infarction, and any revascularization) and secondary device-oriented end point (combination of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization), definite/probable stent thrombosis, and major/minor bleeding were evaluated at 2 years. .009) was also present in the TA group compared with the nonthrombus aspiration group. At 2-year follow-up, no differences in clinical end point were observed between groups. Conclusions-Manual TA during primary percutaneous coronary intervention is associated with a higher rate of direct stenting, a lower rate of postdilatation, and larger and less stents in comparison with conventional primary percutaneous coronary intervention. Conversely, manual TA had no apparent impact on clinical outcomes at long-term follow-up. Clinical Trial Registration-http://www.clinicaltrials.gov. Unique identifier: NCT00828087.(Circ Cardiovasc Interv. 2014;7:294-300.)

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“…15 Lipid pool-like images were the only qualitative IVUS finding independently predictive of no-reflow (odds ratio [OR], 118; 95% confidence interval [CI], 1.28-11008) 15 (Table 1). [14][15][16][17][18][19][20][21][22][23] In another study of 140 patients with STEMI undergoing PCI, IVUS detection of an intracoronary mobile mass (which is usually suggestive of thrombus) was more common in patients with angiographic evidence of distal embolization compared with those without (75% versus 16%; P<0.001; adjusted OR, 53; 95% CI, 2.7-1040.7; Table 1). 19 A larger study of 220 patients with ACS (49.5% with STEMI) found results similar to these 2 previous studies, demonstrating that patients with transient no-reflow were more likely to have eccentric plaque (60% versus 32%; P<0.01), plaque rupture (25% versus 9%; P<0.05), lipid pool-like images (65% versus 37%; P<0.05), and thrombus (80% versus 33%; P<0.0001).…”

Section: Grayscale Intravascular Ultrasoundmentioning

confidence: 99%

Intracoronary and Noninvasive Imaging for Prediction of Distal Embolization and Periprocedural Myocardial Infarction During Native Coronary Artery Percutaneous Intervention

Patel

Brayton

Mintz

et al. 2013

Circ: Cardiovascular Imaging

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T he incidence of periprocedural myocardial infarction (MI) after percutaneous coronary intervention (PCI) ranges from 2% to 50%, depending on the clinical presentation, type of procedure, choice of biomarker (creatine kinase [CK]-MB or troponin), and the threshold used to qualify the diagnosis. 1 Because of this heterogeneity of definition, the prognostic implications of periprocedural MI are controversial. However, several studies have demonstrated that periprocedural MI is associated with worse in-hospital, short-term, and long-term clinical outcomes, including death, recurrent MI, and need for revascularization. [3][4][5] Various mechanisms can lead to periprocedural MI, such as side branch occlusion or vessel spasm; however, distal embolization of atheroma or thrombus seems to be a dominant cause. 6 In a cardiac MRI (cMRI) study of patients undergoing complex native coronary PCI, elevated troponin levels post-PCI correlated with new myocardial enhancement because of side branch occlusion in 43% of cases and in the apical myocardium distal to the stent in 57% of cases, as would be expected with distal embolization. 7Numerous studies have documented the occurrence of distal embolization during both elective and urgent PCI and have characterized its histopathologic substrate. In an analysis of catheter-retrieved materials from human studies of patients undergoing PCI for acute coronary syndrome (ACS), 8 those with no-reflow had significantly higher amounts of visible atheroma and microscopic components such as platelet-fibrin complexes, cholesterol crystals, and macrophages. 8 In another study of 37 lesions in 35 patients undergoing elective PCI, microscopic particles were captured by embolic protection devices (EPDs) in 28 (75.6%) lesions.9 Thrombotic components (fibrin strand-entrapped platelets, leukocytes, and red cells) accounted for the majority (≈75%) of captured debris, whereas plaque components (fibrous tissue, calcium spots, acellular amorphous material, macrophages, foam cells, and cholesterol clefts) accounted for the minority (≈25%).9 Similar findings were demonstrated among 33 patients undergoing either native or saphenous vein graft PCI.10 Supporting these in vivo findings, in a postmortem analysis of patients who died of ischemic heart disease, many had evidence of coronary microemboli, composed of cholesterol crystals, hyaline, and platelet aggregates. 11Clinically, distal embolization can result in asymptomatic biomarker elevation or symptomatic ischemia; angiographically, it can present as visually undetectable silent embolization, macroembolization resulting in epicardial coronary obstruction, or severe microvascular obstruction resulting in no-reflow.Coronary angiography has limited capacity to assess the risk for distal macro-or microembolization. The development of advanced intracoronary imaging techniques and noninvasive imaging techniques, such as coronary computed tomography angiography (CCTA) and cMRI, provides an opportunity for detailed analysis of plaque composition, which can pot...

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Comparison of Coronary Arterial Finding by Intravascular Ultrasound in Patients With “Transient No-Reflow” Versus “Reflow” During Percutaneous Coronary Intervention in Acute Coronary Syndrome

Cited by 79 publications

References 12 publications

Impact of Culprit Plaque Composition on the No-Reflow Phenomenon in Patients With Acute Coronary Syndrome An Intravascular Ultrasound Radiofrequency Analysis

Impact of Culprit Plaque Composition on the No-Reflow Phenomenon in Patients With Acute Coronary Syndrome An Intravascular Ultrasound Radiofrequency Analysis

Optimization in Stent Implantation by Manual Thrombus Aspiration in ST-Segment–Elevation Myocardial Infarction

Intracoronary and Noninvasive Imaging for Prediction of Distal Embolization and Periprocedural Myocardial Infarction During Native Coronary Artery Percutaneous Intervention

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