Patterns of intracoronary thrombus by high-definition intravascular ultrasound

Groenland, Frederik T.W.; Ligthart, Jürgen; Witberg, Karen; Daemen, Joost

doi:10.4244/eij-d-21-00796

Cited by 5 publications

(9 citation statements)

References 2 publications

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“…Preintervention IVUS assessment revealed a ruptured plaque in 48.0% and convex calcium, which has been closely related to calcified nodules both in vivo and ex vivo, in 10.0% 14,23 . The lower rate of IVUS‐identified plaque ruptures as compared to histopathological findings (48% vs. 55%–60%, respectively) is likely explained by the presence of thrombus masking the ruptured site due to ultrasound attenuation 15 . Conversely, the identification of convex calcium is less affected by this phenomenon due to its bright and protruding appearance.…”

Section: Discussionmentioning

confidence: 92%

“…Qualitative IVUS parameters included different plaque types, as well as the presence of a plaque rupture and/or convex calcium. Three different IVUS‐defined types of thrombus were distinguished: acute, subacute, and organized thrombus 15 . Furthermore, the total thrombus length, the occlusive thrombus length, and the maximum thrombus angle were determined.…”

Section: Methodsmentioning

confidence: 99%

“…Preintervention IVUS assessment of culprit lesions in STEMI patients allows plaque characterization and thrombus evaluation. It thereby unravels underlying mechanisms causing luminal thrombosis, such as plaque rupture and convex calcium, and visualizes different types of thrombus 11–15 …”

Section: Introductionmentioning

confidence: 99%

“…It thereby unravels underlying mechanisms causing luminal thrombosis, such as plaque rupture and convex calcium, and visualizes different types of thrombus. [11][12][13][14][15] As of to date, a dedicated prospective study investigating culprit lesion plaque morphology and thrombus directly after vessel wiring (so before any lesion preparation, such as aspiration thrombectomy or predilatation), is lacking. Therefore, the aim of this study was to qualify and quantify preintervention culprit lesion plaque characteristics and thrombus using high-definition IVUS (HD-IVUS) in patients presenting with STEMI.…”

Section: Introductionmentioning

confidence: 99%

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Culprit lesion plaque characterization and thrombus grading by high‐definition intravascular ultrasound in patients with ST‐segment elevation myocardial infarction

Groenland

Plantes

Neleman

et al. 2023

Cathet Cardio Intervent

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Background Dedicated prospective studies investigating high‐definition intravascular ultrasound (HD‐IVUS)‐guided primary percutaneous coronary intervention (PCI) are lacking. The aim of this study was to qualify and quantify culprit lesion plaque characteristics and thrombus using HD‐IVUS in patients presenting with ST‐segment elevation myocardial infarction (STEMI). Methods The SPECTRUM study is a prospective, single‐center, observational cohort study investigating the impact of HD‐IVUS‐guided primary PCI in 200 STEMI patients (NCT05007535). The first 100 study patients with a de novo culprit lesion and a per‐protocol mandated preintervention pullback directly after vessel wiring were subject to a predefined imaging analysis. Culprit lesion plaque characteristics and different thrombus types were assessed. An IVUS‐derived thrombus score, including a 1‐point adjudication for a long total thrombus length, long occlusive thrombus length, and large maximum thrombus angle, was developed to differentiate between low (0–1 points) and high (2–3 points) thrombus burden. Optimal cut‐off values were obtained using receiver operating characteristic curves. Results The mean age was 63.5 (±12.1) years and 69 (69.0%) patients were male. The median culprit lesion length was 33.5 (22.8–38.9) mm. Plaque rupture and convex calcium were appreciated in 48 (48.0%) and 10 (10.0%) patients, respectively. Thrombus was observed in 91 (91.0%) patients (acute thrombus 3.3%; subacute thrombus 100.0%; organized thrombus 22.0%). High IVUS‐derived thrombus burden was present in 37/91 (40.7%) patients and was associated with higher rates of impaired final thrombolysis in myocardial infarction flow (grade 0–2) (27.0% vs. 1.9%, p < 0.001). Conclusions HD‐IVUS in patients presenting with STEMI allows detailed culprit lesion plaque characterization and thrombus grading that may guide tailored PCI.

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Section: Discussionmentioning

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Culprit lesion plaque characterization and thrombus grading by high‐definition intravascular ultrasound in patients with ST‐segment elevation myocardial infarction

Groenland

Plantes

Neleman

et al. 2023

Cathet Cardio Intervent

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“…The images suggested a subacute, homogeneous, echolucent thrombus in a large extension of the RCA, RPD branch, and RPV branch. Additionally, they showed an acute thrombus with a bright aspect, clear outline and no signal attenuation in the RPV branch (Figure 5 )[ 7 ]. We believe that the presence of thrombi on IVUS in the acute and subacute stages was due to the fact that at the time the patient was studied, the process had already been evolving for over 24 h and the thrombotic process (when it does not culminate with vessel occlusion) is a continuum of thrombus stages.…”

Section: Case Presentationmentioning

confidence: 99%

Extensive right coronary artery thrombosis in a patient with COVID-19: A case report

Dall'Orto¹,

Lopes²,

Cancela³

et al. 2022

World J Clin Cases

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BACKGROUND Occurring in approximately 30% of hospitalized patients, cardiovascular complications that take place during the course of coronavirus disease 2019 (COVID-19) have been shown to cause morbidity and mortality. This case is the first report of extensive right coronary artery (RCA) thrombosis that was evaluated by intracoronary imaging and intracoronary invasive physiology in a patient with COVID-19. CASE SUMMARY A 62-year-old woman presented with flu-like symptoms; ten days later, she presented with inferior ST-segment elevations, chest pain, dyspnea, nausea and vomiting. The patient was diagnosed with COVID-19 following a positive test result. Emergency angiography of the RCA and its branches indicated intraluminal filling defects, suggesting a thrombus. Intravascular ultrasound confirmed a subacute thrombus in the RCA, the right posterior descending branch and the right posterior ventricular (RPV) branch. There was also an acute thrombus in the RPV branch and atherosclerosis in the RCA. Dual antiplatelet/ anticoagulation therapy was administered. After 7 d, angiography revealed complete disappearance of the thrombi. Optical coherence tomography confirmed this with the exception of a small thrombus in the RPV branch and atherosclerotic plaque in the RCA. The atherosclerotic RCA was measured using the resting full-cycle ratio, indicating no impairment to coronary physiology. The patient was discharged on the 11 th day of hospitalization and remained asymptomatic through the 6-mo follow-up. CONCLUSION This was the first report of RCA thrombosis in a patient with COVID-19. Dual antiplatelet/anticoagulation therapy was successful.

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Juxtaposition of urgent angioplasty results in spontaneous coronary artery dissection: a case report of fresh vs. organized intramural haematoma

McConkey

Maria

2023

European Heart Journal - Case Reports

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Background Coronary intramural haematoma from spontaneous coronary artery dissection (SCAD) presents as an acute coronary syndrome, usually in young or middle-aged female patients. Conservative management in the absence of ongoing symptoms is best practice, and the artery eventually heals fully. Case Summary A 49-year-old female presented with a non-ST elevation myocardial infarction. Initial angiography and intravascular ultrasound (IVUS) demonstrated typical intramural haematoma of the ostial to mid left circumflex artery. Initial conservative management was selected, but patient developed further chest pain 5-days later, and with worsening electrocardiogram changes. Further angiography was carried out demonstrating near occlusive disease with organised thrombus in the false lumen. The angioplasty result from this is juxtaposed with another acute SCAD case on the same day with fresh intramural haematoma. Discussion Re-infarction is a common occurrence in SCAD and little is known about how to predict it. These cases demonstrate the appearance on IVUS of fresh versus organised thrombus and the relative angioplasty result in each case. Follow-up IVUS due to ongoing symptoms in one patient demonstrated significant stent malapposition, not apparent at the index intervention, in all likeliness due to intramural haematoma regression.

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Patterns of intracoronary thrombus by high-definition intravascular ultrasound

Cited by 5 publications

References 2 publications

Culprit lesion plaque characterization and thrombus grading by high‐definition intravascular ultrasound in patients with ST‐segment elevation myocardial infarction

Culprit lesion plaque characterization and thrombus grading by high‐definition intravascular ultrasound in patients with ST‐segment elevation myocardial infarction

Extensive right coronary artery thrombosis in a patient with COVID-19: A case report

Juxtaposition of urgent angioplasty results in spontaneous coronary artery dissection: a case report of fresh vs. organized intramural haematoma

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