Angioscopic evaluation of thrombi in the culprit coronary lesions in patients with acute myocardial infarction (original) (raw)
Related papers
International Journal of Cardiology, 2007
A 56-year-old man was admitted because of acute myocardial infarction for 10 h of onset. Emergent coronary angiography showed a total occlusion at the middle portion of the right coronary artery. After aspirating thrombus, high-grade stenosis was present in the distal segment. Angioscopy showed only a white thrombus, but not a yellow plaque nor a red thrombus at the initially occluded site. On the other hand, IVUS demonstrated large attenuation indicating a lipid core and cavity obstruction and angioscopy revealed a glittering yellow plaque and red thrombi in the distal segment. Precipitation of thrombus from the distal site to the middle site might have occurred. IVUS and angioscopy might be effective for detecting and evaluating the infarct-related vulnerable plaque and for making the therapeutic strategy when percutaneous coronary interventions are performed.
2017
Annals of PIMS ISSN:1815-2287 Ann. Pak. Inst. Med. Sci. 2017 18 Introduction Ischemic heart disease takes a heavy toll on a country’s economy. It is the leading cause of death in Europe and North America. According to AHA estimates, the overall prevalence of CAD in USA over 1999-2006 has been 7.6% (Female 10.4% versus males 4.8%) . The annual number of adults per 100 having a diagnosed heart attack or fatal coronary heart disease was reported as 125 in males and 10 in females in 55-75 years age group. Approximately 0.8 million Americans sustain a new coronary event every year and approximately 5 million develop a recurrent episode. One of every six deaths was caused by coronary artery disease in 2007. With the advent of reperfusion and thrombolytic therapy, diminutive annual mortality rates for patients with acute MI have been noted in the Western world. Scarcity of literature reporting prevalence, annual incidence, mortality rate and economic burden exists in Pakistan but several s...
Morphology of acute myocardial infarction in relation to coronary thrombosis
American Heart Journal, 1974
ABSTRACT The relationships between the following were examined in 100 patients who died within 25 days after presenting with clinical and pathological evidence of a myocardium infarction: frequency of acute coronary occlusion, degree and length of old fibrous-atheromatous stenosis at the site of eventual coronary occlusion, size, type, and location of the infarct, size of pre-existing scars, weight of the heart, irreversible shock, and anticoagulant therapy.In 62 cases no acute occlusive lesion was present, while in 38 cases an occlusive thrombus was found always located at the site of an old severe stenosis. The presence of the thrombus correlated with the increasing size of the infarct, the increasing length of the pre-existing stenosis. The present findings support the hypothesis that the thrombus is a secondary phenomenon related to flow redistribution by collateral vessels in stenosed arteries.
Coronary thrombosis in myocardial infarction
The American Journal of Cardiology, 1974
Schwartz la/21 (66%) 164/170 (96.5%) 45150 06%) 2* 41 21 Occlusion of extramural artery usually subtends infarct and is separated from it by uninvolved segment of artery Infarcts occur.in region supported by occluding artery Site of myocardial necrosis corresponds properly with artery containing thrombus Thrombi often in two arterial segments. Most thrombi proximal and anatomically subtend infarct Constant local relation between thrombosed artery and supported area infarcted * Age estimated by histologic criteria. f Cases selected only for study of radioactive thrombi. 1 Age estimated from time of onset of clinical manifestations of infarction. 0 Only 6 cases had infarcts from 3 to 6 weeks old.
Cardiovascular Pathology, 2014
Thrombus aspiration in the setting of primary percutaneous coronary intervention is a recently recommended technique that facilitates thrombus removal from the culprit lesions in acute myocardial infarction (AMI) patients. Thrombectomy specimens from 50 patients with symptoms of AMI lasting usually not more than 12 h were examined by methods of routine histology, immunohistochemistry (IHC), and electron microscopy (ELMI). In 36 patients, there were fresh thrombi, in 10 older thrombi (8 of them with simultaneous presence of a fresh thrombi) and in 3 atheroma material only (in additional 7 patients atheroma material was admixed to the thrombi), and in one patient, there was carcinoma embolus. To help to distinguish between fresh and older thrombi, we recommend IHC (presence of macrophages and endothelia) and ELMI (loss of density of the erythrocyte matrix and presence of macrophages). On the other hand, changes of neutrophils (IHC degranulation/lysis) and of platelets (ELMI degranulation) appear early and thus contribute little to distinguishing between fresh and older thrombi. It could be concluded that, in a substantial proportion of patients with AMI, there is a discrepancy between duration of the symptoms and microscopic picture of the coronary thrombus. The thrombus may apparently be symptomless for a period of days or even weeks.
Arteriosclerosis, Thrombosis, and Vascular Biology, 2011
Because fibrin is transparent and almost invisible by any conventional imaging methodologies, clinical examinations of coronary fibrin thrombus have been ignored, and little is known about its role in the genesis of acute coronary syndrome (ACS). The present study was performed to visualize coronary fibrin thrombus and to examine its role in ACS. Dye-staining coronary angioscopy using Evans blue dye, which selectively stains fibrin blue but does not stain blood corpuscles, was performed for observation of globular coronary thrombi in 111 ACS patients. The thrombi were aspirated for histological examination. The thrombi were classified by visual appearance into 8 transparent, 3 light-red, 2 frosty glass-like and membranous, 32 white, 8 brown, 34 red, and 19 red-and-white in a mosaic pattern. Transparent thrombi that were not visible by conventional angioscopy were visualized as a blue structure by dye-staining angioscopy, and they were observed in patients with unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI). The thrombi caused total or subtotal coronary occlusion. The aspirated thrombi were composed of fibrin alone by histology. Fibrin-rich thrombi were visualized using dye-staining angioscopy in 60% of 50 patients with UA+NSTEMI and in 29% of 61 patients with ST-elevation myocardial infarction. By histology of the aspirated thrombi, fibrin-rich thrombi were observed in 71% of 33 patients with UA+NSTEMI and in 28% of 35 patients with ST-elevation myocardial infarction. Fibrin-rich coronary thrombi were frequently observed by both dye-staining angioscopy and histology in ACS patients. Rarely, fibrin itself formed a globular thrombus and caused coronary occlusion.
Angiographic features of the coronary arteries during intracoronary thrombolysis
Heart, 1984
The angiographic appearance of the coronary arteries during successful thrombolysis with urokinase was determined in 35 patients with acute myocardial infarction. The lysing process passed through several phases: (a) total coronary occlusion with a convex or irregular distal margin (phase 0); (b) increasing patency of the lumen (phase 1); (c) re-establishment of flow but with intraluninal filling defects and delayed distal flow possibly due to microemboli (phase 2); (d) partial or complete disappearance of the filling defects (phase 3); and (e) further widening of the lumen which eventually attains a smooth regular outline (phase 4). The angiographic features which indicate the presence of coronary thrombosis are occlusion with an irregular or scalloped margin, stining with contrast medium, and progressive patency of the occluded vessel showing intraluminal filling defects. Coronary thrombosis occurring during the first hours after acute myocardial infarction has recently been reported with increased frequency,13 and its relation with transmural necrosis has been established. Thrombolytic treatment has been successfully used to achieve reperfusion of occluded coronary arteries.4-6 Although coronary angiography has become crucial in