Safety and Efficacy of Intense Antithrombotic Treatment and Percutaneous Coronary Intervention Deferral in Patients With Large Intracoronary Thrombus

Echavarría‐Pinto, Mauro; Lopes, Ricardo; Gorgadze, Tamara; Gonzalo, Nieves; Hernández, Rosana; Jiménez‐Quevedo, Pilar; Alfonso, Fernándo; Bañuelos, Camino; Núñez‐Gil, Iván J.; Ibáñez, Borja; Fernández, Cristina; Fernández‐Ortíz, Antonio; Garcı́a, Eulogio; Macaya, Carlos; Escaned, Javier

doi:10.1016/j.amjcard.2013.02.027

Cited by 20 publications

(15 citation statements)

References 24 publications

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“…In the series as a whole, there were no acute events (ACS or sudden death). Previous studies investigated the feasibility of deferred PCI for STEMI treatment under optimal antithrombotic therapy, on the basis of angiographic findings only 39,40 . These series reported that this procedure could be performed safely in selected patients and also induced a decreased rate of culprit lesion stenting.…”

Section: Discussionmentioning

confidence: 99%

Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions

Amabile¹,

Combaret²,

Hammas³

et al. 2015

EuroIntervention

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2 STRUCTURED ABSTRACT Aims:To assess whether a strategy of invasive management without stents in selected acute coronary syndrome (ACS) patients with a large thrombus burden (LTB) might be feasible and safe. Methods and results:We performed a prospective non-randomised observational cohort study of invasive treatment decisions guided by optical coherence tomography (OCT) in selected ACS patients with LTB.Among 852 ACS patients who had undergone invasive coronary angiography, 101(11.8%) patients with large thrombus burden on initial angiography underwent thrombectomy to restore TIMI-3 flow without stenting. All of these patients then had repeat angiography with OCT (Day 0-2 (Group1), Day 3-6 (Group2) or Day 7-30 (Group3)).No adverse events occurred between the initial and second angiograms. Residual thrombus was detected in 68% of patients with OCT (respectively, 94%, 79% and 32% in Group1, Group2 and Group3) and 20% of cases with angiography. Plaque rupture was detected by OCT in 65% of cases. Minimal lumen area was 2.81mm 2 , 3.40mm 2 and 4.89mm 2 in Group1, Group2 and Group3, respectively. 62% of patients were stented (respectively, 76%, 61% and 50%). During a minimum follow-up period of 12 months in all patients, 1 non-fatal MI occurred and 1 PCI was performed for angina. Conclusions:Medical management without stents is safe and feasible in selected ACS patients with LTB.OCT revealed culprit lesion characteristics that were not disclosed by angiography and facilitated treatment decisions. 3 KEY WORDSAcute coronary syndrome, optical coherence tomography, coronary thrombosis, myocardial infarction, percutaneous coronary intervention. 4 CONDENSED ABSTRACTWe assessed the feasibility and safety of invasive management and selected stenting or not, as guided by angiography and OCT, in ACS patients with LTB. In a 2-stage strategy, angiography was used to select patients for delayed stenting, and in the second procedure angiography and OCT were used to decide on stenting or not. OCT improved the assessment of culprit lesion characteristics and thrombus burden. Of 101 STEMI patients, 38% did not receive a stent. There were no adverse events related to OCT and only 2 non-fatal MACEs occurred during 12 months of follow-up. 5 ABBREVIATIONS LIST

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Section: Discussionmentioning

confidence: 99%

Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions

Amabile¹,

Combaret²,

Hammas³

et al. 2015

EuroIntervention

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“…Embolic protection devices have also been used to decrease the risk of no-reflow in primary PCI, although the clinical or angiographic bene fits are unclear. 4,74 Reduced thrombotic burden in the culprit artery in patients with or without STEMI have also been reported with use of aspiration throm bectomy 5 or pharmacological prevention strategies, 75 which has been associated with decreased risk of no-reflow. All this evidence supports the hypothesis that embolization of microthrombi and plaque components from the culprit coronary segment are causative in no-reflow after PCI in patients with STEMI.…”

Section: The Role Of Ischaemiamentioning

confidence: 97%

Intramyocardial haemorrhage after acute myocardial infarction

et al. 2014

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In patients with acute myocardial infarction (AMI), the guideline-recommended treatment is mechanical revascularization by percutaneous coronary intervention (PCI), which is effective at reducing mortality. However, a substantial proportion of patients with AMI develop chronic cardiac failure owing to poor restoration of microvascular function and myocardial perfusion, despite restoration of epicardial vessel patency. This occurrence is called the 'no-reflow' phenomenon. Although pathological and clinical observations initially seemed to support the hypothesis that no-reflow was the result of microvascular obstruction, irreversible microvascular injury and subsequent intramyocardial haemorrhage are now also thought to be important factors in this process. Intramyocardial haemorrhage shares several pathophysiological features with the haemorrhagic transformation that occurs after ischaemic stroke. Understanding of the role of intramyocardial haemorrhage in the no-reflow phenomenon and myocardial injury is crucial to the development of new therapeutic strategies to treat AMI. In this Review, we provide a comprehensive overview of the pathogenesis and clinical relevance of intramyocardial haemorrhage, and discuss diagnostic options and future therapeutic strategies.

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“…In thrombolysis, regimens of intravenous thrombolytic agents were found to be as efficacious as intracoronary delivery (19). According to Mauro et al, intense antithrombotic treatment, including glycoprotein IIb/IIIa in-hibitors and PCI deferral (not performing PCI immediately), were safe and effective for acute coronary syndrome patients who had a large intracoronary thrombus (20). However, glycoprotein IIb/IIIa inhibitors are not available in Japan, and the intracoronary thrombus volume in our patient was more than 30 times greater than that reported by Mauro et al; therefore, we initially chose treatment with PCI.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Acute Myocardial Infarction with Multivessel Coronary Artery Ectasia Successfully Treated with Percutaneous Coronary Intervention and Systemic Thrombolysis

et al. 2015

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Coronary artery ectasia (CAE) is defined as a coronary artery dilatation with a diameter ! 1.5 times greater than that of a normal adjacent artery. All 3 coronary vessels can be affected by CAE, but the incidence of multivessel CAE among patients undergoing coronary angiography is quite low. We herein report an extremely rare case of acute myocardial infarction due to massive thrombi in the giant right coronary artery with multivessel CAE. Thrombus aspiration during percutaneous coronary intervention may be limited in giant coronary artery cases, and systemic thrombolysis may be effective in patients with massive thrombi in the giant coronary artery.

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Safety and Efficacy of Intense Antithrombotic Treatment and Percutaneous Coronary Intervention Deferral in Patients With Large Intracoronary Thrombus

Cited by 20 publications

References 24 publications

Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions

Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions

Intramyocardial haemorrhage after acute myocardial infarction

A Rare Case of Acute Myocardial Infarction with Multivessel Coronary Artery Ectasia Successfully Treated with Percutaneous Coronary Intervention and Systemic Thrombolysis

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