Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions

Amabile, Nicolas; Combaret, Nicolas; Hammas, Sami; Prati, Francesco; Berry, Colin; Pereira, Bruno; Lusson, Jean-René; Caussin, Christophe; Motreff, Pascal

doi:10.4244/eijy14m07_18

Cited by 42 publications

(28 citation statements)

References 32 publications

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“…Cafri et al 9 reported a lower rate of thrombus-related angiographic events in patients treated with DS 4.9 days after the first procedure (4% versus 27% for IS; P=0.03). 24 showed that it can take >7 days to achieve complete thrombus regression.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Immediate With Delayed Stenting Using the Minimalist Immediate Mechanical Intervention Approach in Acute ST-Segment–Elevation Myocardial Infarction

Belle

Motreff

Mangin

et al. 2016

Circ: Cardiovascular Interventions

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Background-Delayed stent implantation after restoration of normal epicardial flow by a minimalist immediate mechanical intervention aims to decrease the rate of distal embolization and impaired myocardial reperfusion after percutaneous coronary intervention. We sought to confirm whether a delayed stenting (DS) approach (24-48 hours) improves myocardial reperfusion, versus immediate stenting, in patients with acute ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Methods and Results-In the prospective, randomized, open-label minimalist immediate mechanical intervention (MIMI)trial, patients (n=140) with ST-segment-elevation myocardial infarction ≤12 hours were randomized to immediate stenting (n=73) or DS (n=67) after Thrombolysis In Myocardial Infarction 3 flow restoration by thrombus aspiration. Patients in the DS group underwent a second coronary arteriography for stent implantation a median of 36 hours (interquartile range 29-46) after randomization. The primary end point was microvascular obstruction (% left ventricular mass) on cardiac magnetic resonance imaging performed 5 days (interquartile range 4-6) after the first procedure. There was a nonsignificant trend toward lower microvascular obstruction in the immediate stenting group compared with DS group (1.88% versus 3.96%; P=0.051), which became significant after adjustment for the area at risk (P=0.049). Median infarct weight, left ventricular ejection fraction, and infarct size did not differ between groups. No difference in 6-month outcomes was apparent for the rate of major cardiovascular and cerebral events. Conclusions-The

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Section: Discussionmentioning

confidence: 99%

Comparison of Immediate With Delayed Stenting Using the Minimalist Immediate Mechanical Intervention Approach in Acute ST-Segment–Elevation Myocardial Infarction

Belle

Motreff

Mangin

et al. 2016

Circ: Cardiovascular Interventions

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“…38 Finally, a recent study investigated the use of OCT to guide the management of patients with ACS and large thrombus burden. 39 The study involved 852 patients with ACS. Of these patients, 101 had large thrombus burden and underwent thrombectomy to restore Thrombolysis In Myocardial Infarction (TIMI) 3 flow.…”

Section: Optimising Percutaneous Coronary Interventionmentioning

confidence: 99%

Intravascular Ultrasound Versus Optical Coherence Tomography for Coronary Artery Imaging – Apples and Oranges?

Rathod¹,

Hamshere²,

Jones³

et al. 2015

Interventional Cardiology Review

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Coronary angiography has been the gold standard technique for evaluating coronary arterial disease for the past 50 years. Increasingly, however, realisation of the limitations of coronary angiography, mainly the inability to supply information regarding the coronary wall, has prompted the design and development of adjunctive technologies to better evaluate not just luminal disease but also the burden and character of atherosclerotic plaque within the vessel. The development of intracoronary imaging modalities, namely intravascular ultrasound (IVUS) and optical coherence tomography (OCT), has progressed quickly and these technologies now have established roles in the diagnosis and treatment of coronary artery disease. In general, intracoronary devices that can assess the coronary endothelium use either acoustic or optical signals that are received by a coronary catheter (IVUS uses ultrasound, OCT uses near-infrared light).This review addresses these two widely used intracoronary imaging techniques, looking at their clinical applications, recent evidence for their use and describes new developments in the field. Intravascular UltrasoundIn the last 25 years IVUS has been established as the most commonly used intracoronary imaging device. An IVUS system consists of a flexible monorail catheter with an ultrasound transducer at its tip that emits ultrasound waves in the 10-40 MHz range and an electronics console to reconstruct the image (see Figure 1).1 After reflection from tissue, part of the ultrasound energy returns to the transducer and is converted into the image.There are two types of IVUS transducers for clinical use: the mechanical rotating transducer and the electronically switched phased array system.The mechanical transducer uses a single crystal on a rotational device, which visualises the entire vessel in cross-section providing better image quality (compared with phased array technology) of 100-150 μm.2 The main disadvantage of mechanical transducers is the central drive shaft that decreases flexibility and prevents the concurrent use of a central guidewire.3 However, newer rotational IVUS catheters have developed a monorail system that allows for the presence of a central guidewire.Phased array catheters use multiple transducer elements, which are mounted along the circumference of the catheter tip. Each element sends and receives ultrasounds from a sector and multiple sectors are gathered to produce a cross-sectional image of the artery. However, they are disadvantaged by a technically complex set-up, requiring detailed programming; 3 but some of the newer catheters are easier to set up.Intracoronary imaging of coronary vessels by IVUS is performed using standard coronary interventional techniques and equipment (guiding catheter and 0.014 inch angioplasty guidewire) for catheter delivery along the guidewire beyond the target lesion/area of interest. Intravenous heparin and glyceryl trinitrate (nitroglycerin) are routinely administered before imaging. The IVUS catheter is then drawn back across the tar...

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“…Although the limited depth of penetration of OCT imaging may limit the assessment of plaque burden and deep tissue structures, prior work has validated the ability of OCT to accurately discriminate different types of plaque and to identify features associated with plaque vulnerability for thrombosis and rupture, which are predominantly located in the superficial part of the vessel. Studies are now underway investigating the use of OCT in guiding clinical decision making, 55 and further improvements in OCT technology should expand its utility in both research and clinical settings.…”

Section: Discussionmentioning

confidence: 99%

Fundamentals of Optical Coherence Tomography

Ong

Jang

2015

Interventional Cardiology Clinics

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Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions

Cited by 42 publications

References 32 publications

Comparison of Immediate With Delayed Stenting Using the Minimalist Immediate Mechanical Intervention Approach in Acute ST-Segment–Elevation Myocardial Infarction

Comparison of Immediate With Delayed Stenting Using the Minimalist Immediate Mechanical Intervention Approach in Acute ST-Segment–Elevation Myocardial Infarction

Intravascular Ultrasound Versus Optical Coherence Tomography for Coronary Artery Imaging – Apples and Oranges?

Fundamentals of Optical Coherence Tomography

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