OCT-Based Diagnosis and Management of STEMI Associated With Intact Fibrous Cap

Prati, Francesco; Uemura, Shiro; Souteyrand, Géraud; Virmani, Renu; Motreff, Pascal; Vito, Luca Di; Biondi‐Zoccai, Giuseppe; Halperin, Jonathan L.; Fuster, Valentín; Ozaki, Yukio; Narula, Jagat

doi:10.1016/j.jcmg.2012.12.007

Cited by 174 publications

(87 citation statements)

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“…Pathology studies by Virmani have shown that ACS are most often due to plaque rupture or erosion 24 ; was and these observations have been subsequently confirmed on IVUS and on OCT 24,26,27 . Fibrous cap thickness is critical to onset of these complications, thickness <65 μm being associated with high risk of rupture 28 .…”

Section: Discussionmentioning

confidence: 91%

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

Amabile¹,

Combaret²,

Hammas³

et al. 2015

EuroIntervention

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2 STRUCTURED ABSTRACT Aims:To assess whether a strategy of invasive management without stents in selected acute coronary syndrome (ACS) patients with a large thrombus burden (LTB) might be feasible and safe. Methods and results:We performed a prospective non-randomised observational cohort study of invasive treatment decisions guided by optical coherence tomography (OCT) in selected ACS patients with LTB.Among 852 ACS patients who had undergone invasive coronary angiography, 101(11.8%) patients with large thrombus burden on initial angiography underwent thrombectomy to restore TIMI-3 flow without stenting. All of these patients then had repeat angiography with OCT (Day 0-2 (Group1), Day 3-6 (Group2) or Day 7-30 (Group3)).No adverse events occurred between the initial and second angiograms. Residual thrombus was detected in 68% of patients with OCT (respectively, 94%, 79% and 32% in Group1, Group2 and Group3) and 20% of cases with angiography. Plaque rupture was detected by OCT in 65% of cases. Minimal lumen area was 2.81mm 2 , 3.40mm 2 and 4.89mm 2 in Group1, Group2 and Group3, respectively. 62% of patients were stented (respectively, 76%, 61% and 50%). During a minimum follow-up period of 12 months in all patients, 1 non-fatal MI occurred and 1 PCI was performed for angina. Conclusions:Medical management without stents is safe and feasible in selected ACS patients with LTB.OCT revealed culprit lesion characteristics that were not disclosed by angiography and facilitated treatment decisions. 3 KEY WORDSAcute coronary syndrome, optical coherence tomography, coronary thrombosis, myocardial infarction, percutaneous coronary intervention. 4 CONDENSED ABSTRACTWe assessed the feasibility and safety of invasive management and selected stenting or not, as guided by angiography and OCT, in ACS patients with LTB. In a 2-stage strategy, angiography was used to select patients for delayed stenting, and in the second procedure angiography and OCT were used to decide on stenting or not. OCT improved the assessment of culprit lesion characteristics and thrombus burden. Of 101 STEMI patients, 38% did not receive a stent. There were no adverse events related to OCT and only 2 non-fatal MACEs occurred during 12 months of follow-up. 5 ABBREVIATIONS LIST

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Section: Discussionmentioning

confidence: 91%

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

Amabile¹,

Combaret²,

Hammas³

et al. 2015

EuroIntervention

Self Cite

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“…This conservative strategy would avoid both early (vessel dissection, distal embolism, and acute stent thrombosis) and late (restenosis, neoatherosclerosis, and late and very late stent thrombosis) complications of stent implantation 10, 11, 12, 13, 14. Indeed, few reports with a small number of cases have suggested that a subset of patients with ST‐segment elevation myocardial infarction caused by PE might be treated by antithrombotic therapy with favorable outcome 2, 15, 16. However, data on the outcomes of patients with ACS caused by rupture or erosion are limited.…”

Section: Introductionmentioning

confidence: 99%

Management and Outcome of Patients With Acute Coronary Syndrome Caused by Plaque Rupture Versus Plaque Erosion: An Intravascular Optical Coherence Tomography Study

Zhu

Zhang

et al. 2017

JAHA

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BackgroundPlaque rupture and erosion are the 2 most common mechanisms for acute coronary syndromes. However, the outcome of these 2 distinct pathologies in patients with acute coronary syndromes has never been studied.Methods and ResultsWe retrospectively studied 141 patients with acute coronary syndromes who underwent optical coherence tomography (OCT) imaging of the culprit lesion prior to stenting from the Massachusetts General Hospital OCT Registry. Management (stent versus no stent), poststent OCT findings, and outcomes were compared. Among the 141 culprit lesions, rupture was found in 79 (56%) patients and erosion in 62 (44%). Stent implantation was performed in 77 (97.5%) patients with rupture versus 49 (79.0%) in those with erosion (P<0.001). Immediately after percutaneous coronary intervention, OCT showed a higher incidence of malapposition (37.5% versus 7.3%, P<0.001), thrombus (59.4% versus 14.6%, P<0.001), and protrusion (93.8% versus 73.2%, P=0.008) in the rupture group compared with the erosion group. Plaque rupture was associated with a higher incidence of no reflow or slow flow and distal embolization. Although cardiac event rates were comparable between the two groups at the 1‐year follow‐up, none of the erosion patients who were treated conservatively without stenting had adverse cardiac events.ConclusionsUnfavorable poststent OCT findings were more frequent in rupture patients compared with erosion patients. A subset of erosion patients who were treated conservatively without stenting remained free of adverse cardiac events for up to 1 year.

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“…84,85) Recent studies suggest that conservative management without stenting may be an option in patients with ACS caused by plaque erosion. 86,87) OCT is the only intracoronary imaging device that can visualize plaque erosion owing to its high resolution. The EROSION study has shown the feasibility and safety of anti-thrombotic therapy without stenting in patients with ACS caused by plaque erosion.…”

Section: Tailored Management In Patients With Plaque Erosionmentioning

confidence: 99%

Optical Coherence Tomography for Study of <i>In Vivo</i> Pathobiology and for Optimization of Percutaneous Coronary Intervention

Sugiyama

Jang

2017

Angioscopy

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Intravascular optical coherence tomography (OCT) is an imaging modality uniquely characterized by its high resolution. OCT can visualize in vivo plaque characteristics and detect vulnerable plaque, such as thin-cap fibroatheroma, which has a large lipid pool with overlying thin fibrous cap. OCT can also help the clinicians to identify the underlying pathology of acute coronary syndrome: plaque rupture, plaque erosion, and calcified nodule. The OCT system enables automated measurement of the lumen diameter, lumen area, and lesion length, which is useful to determine appropriate reference sites, stent size and stent length during percutaneous coronary intervention (PCI). Evaluation of underlying plaque characteristics is helpful in predicting possible complications after PCI. OCT-guided PCI may acquire comparable angiographical and clinical outcomes to intravascular ultrasound-guided PCI. OCT can be used to evaluate characteristics of non-culprit plaque and efficacy of lipidlowering therapy on plaque stabilization. OCT also clearly visualizes mechanical vessel injury after stent implantation. Notably, the presence of irregular tissue protrusion has been shown to be associated with the occurrence of device-oriented clinical events. Recent studies suggest that OCT is feasible for the selection of conservative management without stenting in patients with acute coronary syndrome caused by plaque erosion.

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OCT-Based Diagnosis and Management of STEMI Associated With Intact Fibrous Cap

Cited by 174 publications

References 2 publications

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

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

Management and Outcome of Patients With Acute Coronary Syndrome Caused by Plaque Rupture Versus Plaque Erosion: An Intravascular Optical Coherence Tomography Study

Optical Coherence Tomography for Study of <i>In Vivo</i> Pathobiology and for Optimization of Percutaneous Coronary Intervention

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