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

17 Scopus citations

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 1 2013

Keywords

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

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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