Reduction of atherothrombotic burden before stent deployment in non‐<scp>ST</scp> elevation acute coronary syndromes: Reduction of myocardial necrosis achieved with nose‐dive manual thrombus aspiration (<scp>REMNANT</scp>) trial. A volumetric intravascular ultrasound study

Zimarino, Marco; Angeramo, Francesca; Prasad, Abhiram; Ruggieri, Benedetta; Malatesta, Sara; Prati, Francesco; Buttitta, Fiamma; Caterina, Raffaele De

doi:10.1002/ccd.26301

Cited by 7 publications

(4 citation statements)

References 27 publications

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“…24) However, clinical studies regarding thrombus aspiration in NSTEMI could not show clinical benefits, 27,28) while thrombus aspiration might decrease atherothrombotic burden. 29) Therefore, there have been no established strategies to reduce slow flow in PCI to the culprit lesion of NSTEMI.…”

Section: Discussionmentioning

confidence: 99%

Determinants of Slow Flow in Percutaneous Coronary Intervention to the Culprit Lesion of Non-ST Elevation Myocardial Infarction

et al. 2018

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Slow flow is a serious complication in percutaneous coronary intervention (PCI) and is associated with poor clinical outcomes. Our previous study revealed that the ratio of stent diameter to vessel diameter was the determinant of slow flow in intravascular ultrasound (IVUS)-guided PCI to the culprit lesion of ST elevation myocardial infarction (STEMI). The purpose of this study was to verify whether the ratio of stent diameter to vessel diameter is the determinant of slow flow in IVUS-guided PCI to the culprit lesion of non-STEMI (NSTEMI). We included 150 NSTEMI patients and divided into the slow flow group (n = 17) and the non-slow flow group (n = 133). The ratio of stent diameter to vessel diameter was significantly larger in the slow flow group (0.77 ± 0.11) than the non-slow flow group (0.71 ± 0.11) (P = 0.03). Multivariate logistic regression analysis revealed that the ratio of stent diameter to vessel diameter (per 0.1 increase: OR 2.06, 95% CI 1.23-3.46, P = 0.006) was the determinant of slow flow after controlling covariates. In conclusion, the ratio of stent diameter to vessel diameter was the determinant of slow flow in IVUS-guided PCI to the culprit lesion of NSTEMI. Unlike other parameters, the ratio of stent diameter to vessel diameter is the modifiable parameters. We may consider the modest stent expansion strategy rather than the aggressive stent expansion strategy in IVUS-guided PCI to the culprit lesion of NSTEMI.

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Section: Discussionmentioning

confidence: 99%

Determinants of Slow Flow in Percutaneous Coronary Intervention to the Culprit Lesion of Non-ST Elevation Myocardial Infarction

et al. 2018

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“…Stroke was defined as a major ischemic or hemorrhagic cerebrovascular accident resulting in disabling neurological symptoms for at least 24 hr. Repeat target‐vessel revascularization was defined as recurrent ischemic symptoms that resulted in the need for revascularization by either PCI or coronary bypass surgery …”

Section: Methodsmentioning

confidence: 99%

“…In total 45 patients with no reflow or slow flow after PCI received intracoronary bolus of glycoprotein IIb/IIIa inhibitors (tirofiban, 10 μg/kg) with a subsequent intravenous infusion (0.15 μg/kg per minute) for 12–24 hr. After the procedure, patients routinely received dual anti‐platelet therapy with aspirin 100 mg and a P2Y12 inhibitor (either clopidogrel 75 mg daily, or ticagrelor 90 twice a day) for 12 months after the primary PCI, and 100 mg aspirin daily was prescribed indefinitely …”

Section: Methodsmentioning

confidence: 99%

Determinants of angiographic thrombus burden and impact of thrombus aspiration on outcome in young patients with ST‐segment elevation myocardial infarction

Dong

et al. 2018

Cathet Cardio Intervent

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Objectives We aimed to investigate the determinants of thrombus burden (TB) and the impact of thrombus aspiration (TA) on outcome in young adults with ST segment elevation myocardial infarction (STEMI). Background The determinants of TB in young STEMI patients are not fully understood now. Methods The 182 young (age ≤ 45 years) STEMI patients, who underwent coronary angiography and percutaneous coronary intervention (PCI) in our hospital from January 2013 to September 2016, were included. Angiographic TB and impact of TA on major adverse cardiac events (MACEs) were evaluated. Median clinical follow‐up period was 875 (641–1,052) days. Results All patients were male, mean age was 40 ± 5 years. High thrombus burden (HTB) was evidenced in 100 (54.9%) patients. TA was performed in 62 out 100 (62%) patients with high TB (HTB) during PCI. The prevalence of hypertension was significantly higher in the HTB group than in the low thrombus burden (LTB) group (75 vs. 17%, P < 0.001). The proportion of smoking, alcohol consumption, and family history of premature coronary artery disease were similar between HTB and LTB groups. During follow‐up, 2 patients died and 31 patients underwent repeat PCI. MACE rate was significantly higher in the HTB group than in the LTB group (24.0 vs. 9.8%, P = 0.012) and significantly lower in HTB patients with TA than HTB patients without TA (14.5 vs. 39.5%, P = 0.018). Conclusions Hypertension is an independent determinant of HTB and TA could be considered as an effective therapeutic option in young male STEMI patients with HTB.

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“…The investigators used IVUS to quantify the percentage increase in lumen volume following thrombus aspiration and showed that aggressive intervention was likely to result in successful stent deployment. 104 Conversely, MRI and PET/CT have been used to determine a lack of clinical efficacy. The dal-PLAQUE study did not show a reduction in vessel wall inflammation using the CTEP inhibitor, dalcetrapib: an agent that is now known to be clinically ineffective.…”

Section: Clinical Translationmentioning

confidence: 99%

Emerging techniques in atherosclerosis imaging

Syed

Fletcher

Forsythe

et al. 2019

BJR

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Atherosclerosis is a chronic immunomodulated disease that affects multiple vascular beds and results in a significant worldwide disease burden. Conventional imaging modalities focus on the morphological features of atherosclerotic disease such as the degree of stenosis caused by a lesion. Modern CT, MR and positron emission tomography scanners have seen significant improvements in the rapidity of image acquisition and spatial resolution. This has increased the scope for the clinical application of these modalities. Multimodality imaging can improve cardiovascular risk prediction by informing on the constituency and metabolic processes within the vessel wall. Specific disease processes can be targeted using novel biological tracers and “smart” contrast agents. These approaches have the potential to inform clinicians of the metabolic state of atherosclerotic plaque. This review will provide an overview of current imaging techniques for the imaging of atherosclerosis and how various modalities can provide information that enhances the depiction of basic morphology.

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Reduction of atherothrombotic burden before stent deployment in non‐ST elevation acute coronary syndromes: Reduction of myocardial necrosis achieved with nose‐dive manual thrombus aspiration (REMNANT) trial. A volumetric intravascular ultrasound study

Abstract: Manual TA reduces atherothrombotic burden in culprit lesions of NSTE-ACS patients before S-PCI and, when deep plaque removal is obtained, TA optimizes subsequent stent expansion. © 2015 Wiley Periodicals, Inc.

Cited by 7 publications

References 27 publications

Determinants of Slow Flow in Percutaneous Coronary Intervention to the Culprit Lesion of Non-ST Elevation Myocardial Infarction

Determinants of Slow Flow in Percutaneous Coronary Intervention to the Culprit Lesion of Non-ST Elevation Myocardial Infarction

Determinants of angiographic thrombus burden and impact of thrombus aspiration on outcome in young patients with ST‐segment elevation myocardial infarction

Emerging techniques in atherosclerosis imaging

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