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

Aristotelis C. Papayannis, Abdul Rahman R Abdel-Karim, Arif Mahmood, Bavana V. Rangan, Lorenza B. Makke, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

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° 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.

Original languageEnglish (US)
Pages (from-to)488-493
Number of pages6
JournalCatheterization and Cardiovascular Interventions
Volume81
Issue number3
DOIs
StatePublished - Feb 2013

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Near-Infrared Spectroscopy
Optical Coherence Tomography
Thrombosis
Lipids
Myocardial Infarction
Mass Media
Platelet Glycoprotein GPIIb-IIIa Complex
Stable Angina
Unstable Angina
Anticoagulants
Stents
Anatomy
Angiography

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Association of coronary lipid core plaque with intrastent thrombus formation : A Near-Infrared Spectroscopy and Optical Coherence Tomography Study. / Papayannis, Aristotelis C.; Abdel-Karim, Abdul Rahman R; Mahmood, Arif; Rangan, Bavana V.; Makke, Lorenza B.; Banerjee, Subhash; Brilakis, Emmanouil S.

In: Catheterization and Cardiovascular Interventions, Vol. 81, No. 3, 02.2013, p. 488-493.

Research output: Contribution to journalArticle

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title = "Association of coronary lipid core plaque with intrastent thrombus formation: A Near-Infrared Spectroscopy and Optical Coherence Tomography Study",
abstract = "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° 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.",
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T1 - Association of coronary lipid core plaque with intrastent thrombus formation

T2 - A Near-Infrared Spectroscopy and Optical Coherence Tomography Study

AU - Papayannis, Aristotelis C.

AU - Abdel-Karim, Abdul Rahman R

AU - Mahmood, Arif

AU - Rangan, Bavana V.

AU - Makke, Lorenza B.

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S.

PY - 2013/2

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N2 - 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° 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.

AB - 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° 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.

KW - acute coronary syndrome

KW - percutaneous coronary intervention

KW - quantitative coronary angiography

KW - thrombosis

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