Association of coronary lipid core plaque with intrastent thrombus formation: A Near-Infrared Spectroscopy and Optical Coherence Tomography Study

作者：Papayannis Aristotelis C; Abdel Karim Abdul Rahman R; Mahmood Arif; Rangan Bavana V; Makke Lorenza B; Banerjee Subhash; Brilakis Emmanouil S^*

来源：Catheterization and Cardiovascular Interventions, 2013, 81(3): 488-493.

DOI：10.1002/ccd.23389

• acute coronary syndrome
• percutaneous coronary intervention
• thrombosis
• quantitative coronary angiography

Background: Optical coherence tomography (OCT) and near-infrared spectroscopy (NIRS) allow assessment of the anatomy (OCT) and composition (NIRS) of coronary lesions. We sought to examine the association between pre-stenting lipid core plaque (LCP), as assessed by NIRS and post-stenting thrombus formation, as assessed by OCT. Methods: We reviewed the angiograms of nine patients who underwent coronary stenting in association with NIRS and OCT imaging. A large LCP by NIRS was defined as at least three 2-mm yellow blocks on the NIRS block chemogram with >200 degrees angular extent. Intracoronary thrombus was defined as a mass of medium reflectivity protruding into the vessel lumen, discontinuous from the surface of the vessel wall. Results: Mean age was 67 +/- 7 years, and all patients were men, presenting with stable angina (56%), unstable angina (11%), or acute myocardial infarction (33%). The mean vessel lipid core burden index (LCBI) was 120 +/- 45, and the mean highest 6-mm LCBI was 386 +/- 190. Three patients had a large LCP and two of them (66%) developed intrastent thrombus after stent implantation compared to none of six patients without large LCPs (0%, P = 0.02). The thrombus resolved after intracoronary glycoprotein IIb/IIIa administration and balloon postdilation. Postprocedural myocardial infarction occurred in 33% versus 17% of patients with and without large LCP, respectively (P = 0.57). Conclusion: Stenting of large LCPs may be associated with intrastent thrombus formation, suggesting that more intensive anticoagulant and/or antiplatelet therapy may be beneficial in such lesions.

• 出版日期2013-2