Intra-coronary thrombus evolution during acute coronary syndrome: regression assessment by serial optical coherence tomography analyses

Amabile, Nicolas; Hammas, Sami; Fradi, S.; Souteyrand, Géraud; Veugeois, Aurélie; Belle, Loïc; Motreff, Pascal; Caussin, Christophe

doi:10.1093/ehjci/jeu228

Cited by 36 publications

(18 citation statements)

References 21 publications

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“…As suggested by Souteyrand et al ., deferred two-step treatment of ACS with optical coherence tomography (OCT) guidance may lead to stenting abstention in more than 30% of cases after large thrombus removal with thrombectomy [ 3 ]. Thrombus regression under optimal pharmacotherapy has also been confirmed by other OCT studies [ 4 ]. Stenting by itself may lead to thrombosis.…”

supporting

confidence: 63%

Is there still a place for thrombectomy?

Dąbrowski

Tyczyński

Bęćkowski

et al. 2016

pwki

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supporting

confidence: 63%

Is there still a place for thrombectomy?

Dąbrowski

Tyczyński

Bęćkowski

et al. 2016

pwki

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“…Previous serial OCT studies of STEMI patients have mainly focused on the chronic phases between 6 and 15 months post-procedure [ 7 , 9 , 15 ]. Recently, Amabile et al investigated thrombus evolution during the very early phase (2–8 days after the onset) of acute coronary syndrome; however, the targeted lesions were treated without stenting [ 8 ]. To the best of the authors’ knowledge, this may be the first study to use FD-OCT to prospectively investigate the very early vascular responses to any type of stent implantation for STEMI lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Insertion of a foreign metal body into thrombus-rich segments may be expected to increase the risk of local thrombogenicity. To investigate the vascular processes after stent implantation, frequency domain-optical coherence tomography (FD-OCT) is an ideal tool because it enables high-resolution imaging of in-stent structures, including quantification of strut coverage [ 6 ], the degree of strut malapposition [ 7 ], and volume of thrombus [ 8 – 10 ], which are considered to be continuous ST risks. Therefore, this study was designed to elucidate the early phase vascular responses after CoCr-EES, focusing on serial changes of clinically relevant intravascular findings for culprit lesions of STEMI using serial FD-OCT analyses.…”

Section: Introductionmentioning

confidence: 99%

Early vascular responses to everolimus-eluting cobalt–chromium stent in the culprit lesions of st-elevation myocardial infarction: results from a multicenter prospective optical coherence tomography study (MECHANISM-AMI 2-week follow-up study)

Morino

Terashita

Otake

et al. 2018

Cardiovasc Interv and Ther

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The use of cobalt-chromium everolimus-eluting stents (CoCr-EES) for ST-segment elevation myocardial infarction (STEMI) reduces the incidence of stent thrombosis compared with bare metal stents, and a substantial difference is apparent in the initial 2 weeks. However, vascular behavior during this early period remains unclear. This was a prospective study (MECH-ANISM-AMI-2W) to investigate early vascular responses in STEMI patients immediately after CoCr-EES implantation and at 2-week follow-up using frequency domain-optical coherence tomography (FD-OCT). The study enrolled 52 patients (age 63.7 ± 11.7 years, male 85.0%), of whom 44 patients were available for complete serial FD-OCT analyses. Both % uncovered struts and % malapposed struts were improved at 2-week follow-up (63 ± 20 vs. 21 ± 14%, p < 0.0001 and 7.3 ± 9.0 vs. 4.7 ± 5.9%, p = 0.005, respectively). Thrombus was decreased, with significant changes in longitudinal length to stent (28.8 ± 27.7 vs. 18.1 ± 20.2%, p = 0.0001) and maximal area (0.93 ± 0.84 vs. 0.65 ± 0.63 mm 2 , p = 0.034). As a result, the average lumen area was significantly larger at 2 weeks (6.49 ± 1.82 vs. 6.71 ± 1.89 mm 2 , p = 0.048, respectively). The number of dissection flaps was lower (0.86 ± 1.11 vs. 0.52 ± 0.90%, p = 0.024). In conclusion, this study showed early vascular responses to CoCr-EES for STEMI lesions-including a significant reduction of thrombus-that resulted in lumen enlargement, earlier progression of strut coverage, and improvements in strut apposition and dissection. The combination of these factors may therefore be responsible for the safety of CoCr-EES within the initial 2 weeks.

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“…ACS includes unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI), and ST segment elevation myocardial infarction (STEMI). The disruption of atherosclerotic plaque and the resulting intracoronary thrombosis are thought to account for most ACS cases [ 1 , 2 ]. Coronary artery disease (CAD) remains the leading cause of death in most developed countries.…”

Section: Introductionmentioning

confidence: 99%

Association between Paraoxonase 1 (PON1) Polymorphisms and the Risk of Acute Coronary Syndrome in a North African Population

et al. 2015

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The purpose of the present study was to investigate the distribution of PON1 Q192R and L55M polymorphisms and activities in a North African population and to determine their association with cardiovascular complications. The prevalence of the QQ, QR, RR, LL, LM, and MM genotypes in the study population was 55.4%, 34.09%, 9.83%, 41.97%, 48.20%, and 9.83% respectively. The Q, R, L, and M alleles had a gene frequency of 0.755, 0.245, 0.67, and 0.33, respectively. The PON1 192 RR genotype was significantly more prevalent among ACS patients than among healthy subjects. There was a 4.33-fold increase in the risk of ACS in subjects presenting the PON1 192 RR genotype compared to those with the QQ genotype (OR=4.33; 95% CI=1.27–17.7). There was a significantly different distribution of PON1 L55M in the ACS patient groups (UA, STEMI, NSTEMI). Moreover, individuals presenting the PON1 55MM genotype present a higher risk for ACS than those with LL genotype (OR=3.69; 95% CI=1.61–11.80). Paraoxonase activities were significantly lower in coronary patients than in healthy subjects. The decrease in PON1 activity was inversely correlated with the number of concomitant risk factors for CVD (r=0.57, p<0.0001). The results of the present study suggested that the PON1 R and M alleles may play a role in the pathogenesis of cardiac ischemia in our North African population and that a decrease in PON1 activity may be a valuable marker for monitoring the development of the atherosclerosis process and the associated cardiovascular complications.

show abstract

Intra-coronary thrombus evolution during acute coronary syndrome: regression assessment by serial optical coherence tomography analyses

Abstract: FD-OCT assessment of thrombus volume in selected ACS patients is feasible, safe, and could allow clot regression monitoring in vivo.

Cited by 36 publications

References 21 publications

Is there still a place for thrombectomy?

Is there still a place for thrombectomy?

Early vascular responses to everolimus-eluting cobalt–chromium stent in the culprit lesions of st-elevation myocardial infarction: results from a multicenter prospective optical coherence tomography study (MECHANISM-AMI 2-week follow-up study)

Association between Paraoxonase 1 (PON1) Polymorphisms and the Risk of Acute Coronary Syndrome in a North African Population

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