Thrombus grading for coronary interventions: the role of contemporary classifications

Development and Validation of a Distal Embolization Risk Score During Primary Angioplasty in ST-Elevation Myocardial Infarction

“…Nevertheless, the accuracy of the highest level (grade 5) is subject to interpretation challenges: because of total occlusion of the vessel, in fact, the relation between the underlying plaque burden and thrombus content is unknown, yet this grade supposedly represents the highest thrombus load. 10 Accordingly, in the present study, the highest value of TTS did not predicted DE, suggesting the weak predictive value of that score in case of total occlusion. We previously reported on angiographic determinants of DE, identifying a subset of lesions at higher risk of embolization: pattern of occlusion of IRA, large RVD (3.5 mm), and lesion length; interestingly, TTS predicted DE only in patients with patent vessel at baseline.…”

“…4e7 In particular, p-PCI in the context of large thrombus burden lesions is strongly associated with DE and poor myocardial reperfusion. 8,9 However, proper assessment of the relative thrombus burden in the context of STEMI lesions is not straightforward, 10 and a systematic DE risk assessment has not been realized at the individual patient level. A risk score for DE during p-PCI in STEMI can be a helpful tool to personalize risk assessment.…”

Determinants of Angiographic Thrombus Burden in Patients With ST-Segment Elevation Myocardial Infarction

“…5,9,10 angiogram, then, after restoring antegrade flow through guidewire or small balloon dilatation in patients with TIMI thrombus grade 5; coronary angiogram enabled restratification of the underlying residual thrombus (final TIMI thrombus grade). 5,9,10 We then stratified the final TIMI thrombus grades as low thrombus burden or high thrombus burden, based on scores 1 to 3 or 4 to 5, respectively. In the final diagnostic angiogram, TIMI flow grades, cTFC, and TMPG measurements were assessed as previously described.…”

Novel thrombus displacement technology for STEMI revascularization

“…Thrombus containing lesions are major pathophysiologic barriers to successful revascularization in acute coronary syndromes [1]. Incorporation of contemporary thrombus classifications can assist in choosing an optimal eradication strategy [2]. Dedicated technologies are available for thrombus handling.…”