Laser Vaporization of Intracoronary Thrombus and Identifying Plaque Morphology in ST-Segment Elevation Myocardial Infarction as Assessed by Optical Coherence Tomography

Abstract

Objectives. We evaluated the thrombus-vaporizing effect of excimer laser coronary angioplasty (ELCA) in patients with ST-segment elevation myocardial infarction (STEMI) by optical coherence tomography (OCT). Background. Larger intracoronary thrombus elevates the risk of interventional treatment and mortality in patients with STEMI. Methods. A total of 92 patients with STEMI who presented within 24 hours from the onset and underwent ELCA following manual aspiration thrombectomy (MT) were analyzed. Results. The mean baseline thrombolysis in myocardial infarction flow grade was 0.4 ± 0.6, which subsequently improved to 2.3 ± 0.7 after MT ( p < 0.0001 ) and 2.7 ± 0.5 after ELCA ( p = 0.0001 ). The median residual thrombus volume after MT was 65.7 mm3, which significantly reduced to 47.5 mm3 after ELCA ( p < 0.0001 ). Plaque rupture was identified by OCT in only 22 cases (23.9%) after MT, but was distinguishable in 36 additional cases after ELCA (total: 58 cases; 63.0%). Ruptured lesions contained a higher proportion of red thrombus than nonruptured lesions (75.9% vs. 43.3%, p = 0.001 ). Significantly larger thrombus burden after MT (69.6 mm3 vs. 56.3 mm3, p < 0.05 ) and greater thrombus reduction by ELCA (21.2 mm3 vs. 11.8 mm3, p < 0.01 ) were observed in ruptured lesions than nonruptured lesions. Conclusions. ELCA effectively vaporized intracoronary thrombus in patients with STEMI even after MT. Lesions with plaque rupture contained larger thrombus burden that was frequently characterized by red thrombus and more effectively reduced by ELCA.

Restenosis after excimer laser coronary atherectomy and drug-coated balloon dilation in Takayasu’s arteritis: a case report and review of the literature

“…However, a post-DCB CAG revealed another ISR despite being symptom-free. Nevertheless, it should be noted that the damage to the coronary intima associated with ELCA might contribute to stent thrombosis and restenosis [ 40 ]. Therefore, despite the potential feasibility of ELCA in TAK with CA involvements, the conservation of coronary intima during ELCA is critical to preventing ISR in the long-term follow-up.…”

Excimer LASER coronary atherectomy for ST-segment elevation myocardial infarction: a multicenter retrospective cohort analysis

“…The efficacy of ELCA in primary PCI for STEMI has not been conclusively proven in a prospective manner, and there are no recommendations in the current guidelines. Although smaller observational studies and case reports have suggested the efficacy of ELCA during primary PCI, 20,[24][25][26] systematic proof of its clinical benefits has not been reported. The present study, which included a substantial number of primary PCI cases using ELCA, failed to show a clinical benefit of ELCA, suggesting that the routine use of ELCA might not be effective for primary PCI.…”

Relationship between thrombolysis in myocardial infarction blood flow before percutaneous coronary intervention and the morphological characteristics of culprit vessel plaques in patients with STEMI

“…1C) (18). In the present study, the culprit lesion was categorized into plaque rupture, plaque erosion or calcified nodule (19). Plaque rupture was defined as the presence of fibrous cap discontinuity and cavity formation in the plaque (Fig.…”