Predictors and time-related impact of distal embolization during primary angioplasty

Napodano, Massimo; Ramondo, Angelo; Tarantini, Giuseppe; Peluso, Diletta; Compagno, S; Fraccaro, Chiara; Frigo, Anna Chiara; Razzolini, Renato; Iliceto, Sabino

doi:10.1093/eurheartj/ehn594

Cited by 91 publications

(76 citation statements)

References 28 publications

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“…The presence of an intracoronary thrombus at the culprit lesion site may increase the risk of distal embolization (DE), resulting in microvascular damage and left ventricular dysfunction during primary percutaneous coronary intervention (p-PCI) [43][44][45][46][47] . In this regard, the use of a mechanical device for thrombus removal or trapping to improve clinical outcomes after p-PCI is attractive, and the efficacy of these devices has been tested in many clinical trials.…”

Section: Thrombus Aspiration/distal Protection Therapy and Its Efficacymentioning

confidence: 99%

“…Several recent studies have demonstrated associations between coronary thrombus characteristics and DE/myocardial perfusion 46,47,77,78,84) , restenosis 80) , the left ventricular (LV) function/remodeling 77,78) and long-term mortality 75) (Table 2).…”

Section: Coronary Thrombus Components and Clinical Outcomesmentioning

confidence: 99%

“…Iwata et al analyzed 108 aspirated thrombi obtained from acute (＜24 hours) or recent (24-72 of intracoronary thrombi at the lesion site has also been shown to increase the risk of DE 44,46,47) . 47) .…”

Section: Restenosismentioning

confidence: 99%

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Thrombus Aspiration Therapy and Coronary Thrombus Components in Patients with Acute ST-Elevation Myocardial Infarction

Yunoki

Naruko

Sugioka

et al. 2013

JAT

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Inflammation and oxidative stress play key roles in atherosclerotic plaque instability, and plaque rupture/erosion and subsequent thrombus formation constitute the principal mechanisms of total vessel occlusion and acute ST-elevation myocardial infarction (STEMI). Plaque disruption triggers the formation of initial platelet aggregates that grow in association with an increase in fibrin formation, leading to persistent coronary flow obstruction and blood coagulation. The fibrin network may trap large numbers of erythrocytes and inflammatory cells to form an erythrocyte-rich thrombus. In fact, previous clinical studies have shown that not only platelet-rich white thrombi, but also erythrocyte-rich red thrombi can be visualized using angioscopy in patients with acute coronary syndrome. Recently, the development of thrombus aspiration and distal protection devices has significantly improved the clinical outcomes of percutaneous intervention in STEMI patients and has enabled the evaluation of antemortem coronary artery thrombi. This is important because previous autopsy studies were unable to differentiate coronary thrombi responsible for myocardial ischemia from postmortem clots. Using frozen samples of aspirated thrombi and specific monoclonal antibodies, we investigated the cellular components of thrombi (platelets, erythrocytes, fibrin and inflammatory cells, such as myeloperoxidase-positive cells) and pathologically evaluated the relationships between erythrocyterich thrombi and inflammation, oxidative stress and clinical outcomes in STEMI patients. Therefore, this review article focuses on the efficacy of thrombus aspiration therapy and the components of aspirated intracoronary thrombi in STEMI patients and presents the results of recent studies regarding the relationship between the composition of aspirated intracoronary thrombi and clinical outcomes.

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Section: Thrombus Aspiration/distal Protection Therapy and Its Efficacymentioning

confidence: 99%

Section: Coronary Thrombus Components and Clinical Outcomesmentioning

confidence: 99%

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Thrombus Aspiration Therapy and Coronary Thrombus Components in Patients with Acute ST-Elevation Myocardial Infarction

Yunoki

Naruko

Sugioka

et al. 2013

JAT

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“…The presence of ICT during acute coronary syndromes often results in suboptimal coronary reperfusion and worse clinical outcomes [7,9,10]. The effect of thrombus on the microvascular circulation can be quantified using degree of ST-segment resolution or the myocardial blush grade [11].…”

Section: Intracoronary Thrombus and Clinical Outcomesmentioning

confidence: 99%

Management of Intracoronary Thrombus

Sathananthan

Watson²,

Overgaard

et al. 2018

Primary Angioplasty

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Partial or complete occlusion of the infarct-related artery (IRA) with intracoronary thrombus (ICT) is the pathognomonic hallmark of patients presenting with ST-elevation myocardial infarction (STEMI). Thrombus burden can be highly variable, but its presence is associated with worse outcomes, including lower procedural success, increased abrupt vessel closure and an increased frequency of major inhospital complications including death and recurrent myocardial infarction (MI). ICT poses a unique series of challenges, but appropriate management is an essential prerequisite for successful primary percutaneous coronary intervention (PPCI). This can largely be achieved using a combination of pharmacological and mechanical approaches prior to coronary stent insertion.In this chapter, we discuss the causes, sequelae and treatment of intracoronary thrombus specific to patients presenting with STEMI.

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“…Therefore, STEMI is considered to have relatively worse prognosis and indicators of prognosis are thrombus burden and components of the thrombus. [1][2][3][4][5][6][7] Recent studies have demonstrated that there may be a delay between development and maturation of thrombus and onset of symptoms. 1 Kramer et al studied aspirated thrombi in a small cohort STEMI patients treated with primary percutaneous coronary intervention within 6 hours of onset of symptoms, for their composition and age.…”

Section: Introductionmentioning

confidence: 99%

Can ischemic time predict the age of thrombus in ST elevation myocardial infarction?: an analysis from tertiary healthcare center in South India

et al. 2016

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INTRODUCTIONAcute ST-elevation myocardial infarction (STEMI) is characterized by thrombotic total occlusion of a coronary artery following coronary atherosclerotic plaque disruption.1 Initial stages of coronary artery stenosis when the plaque disruptions are covered by mural thrombi, mostly remain asymptomatic. Over the time, ABSTRACTBackground: ST Elevation myocardial infarction (STEMI) is characterized by plaque disruption with superimposed thrombus formation. However, studies from western population have suggested a delay between plaque disruption and the onset of symptoms. There is a paucity of Indian data on the relationship between ischemic time and the age of thrombus. Hence, we decided to study the histopathological characteristics of thrombus aspirated during primary percutaneous coronary intervention (PPCI) in patients of STEMI and its relation with the ischemic time. Methods: 107 consecutive patients of STEMI undergoing PPCI with thrombus aspiration, mostly within 12 hours of symptom onset were included in this study. The aspirated thrombi were fixed in 10% formalin, processed and analysed by light microscopy. The thrombi were categorized as recent or lysed according to the histopathological characteristics. Results: The mean age of the study population was 54.93 13.19 years. There were males 94 (87.85%) and 13(12.15%) were females. The culprit vessel was LAD in 36 (32.73%), RCA in 57 (51.82%) and LCX in 13 (11.82%). Left Main, Diagonal and OM were culprit vessels in one case (0.91%) each. Thrombus was identified in 102 (95.3%) out of 107 patients where as in five patients (4.7%) only plaque was seen. Histopathology revealed lysed thrombus in 68 (66.7%) of 102 patients, and recent thrombus in 34 (33.3%) patients. Conclusions: In patients with STEMI, undergoing PPCI within 12 hours of symptom onset, majority of the thrombi were lysed indicative of a thrombus age of at least 24 hours. This suggests that plaque instability and thrombus formation frequently precedes the onset of symptoms. Hence, ischemic time cannot predict the age of thrombus in STEMI.

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Predictors and time-related impact of distal embolization during primary angioplasty

Cited by 91 publications

References 28 publications

Thrombus Aspiration Therapy and Coronary Thrombus Components in Patients with Acute ST-Elevation Myocardial Infarction

Thrombus Aspiration Therapy and Coronary Thrombus Components in Patients with Acute ST-Elevation Myocardial Infarction

Management of Intracoronary Thrombus

Can ischemic time predict the age of thrombus in ST elevation myocardial infarction?: an analysis from tertiary healthcare center in South India

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