The impact of thrombus as a cause and as a result of complicated percutaneous coronary intervention

Judit Karacsonyi, Timothy Henry, Imre Ungi, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Treating thrombotic coronary lesions can be challenging because of the difficulty in wiring the lesion, restoring antegrade flow, and preventing (or treating) distal embolization. Potent antithrombin and antiplatelet therapy is essential to prevent thrombus propagation. Wiring of thrombotic lesions can be aided by the use of soft, polymer-jacketed guidewires, with careful monitoring of the wire course to minimize the risk of perforation. Wiring and/or inflation with a small balloon can often restore some antegrade flow. In patients without active ischemia and large thrombus, deferral of stent implantation by 24-48 h may allow reduction of the thrombus burden and improve the safety of stenting. If stenting is required in areas with large thrombus, aspiration thrombectomy can reduce thrombus burden, but may be associated with a higher risk for stroke. Laser is another treatment option. Thrombus can also form during complex percutaneous intervention as a result of subtherapeutic antithrombotic management or due to decreased coronary flow. Treating the underlying cause of thrombus formation is critical for improving outcomes in these high-risk cases.

Original languageEnglish (US)
Title of host publicationCardiovascular Thrombus
Subtitle of host publicationFrom Pathology and Clinical Presentations to Imaging, Pharmacotherapy and Interventions
PublisherElsevier
Pages203-216
Number of pages14
ISBN (Electronic)9780128126158
ISBN (Print)9780128126165
DOIs
StatePublished - Jan 1 2018

Keywords

  • Anticoagulation
  • Antiplatelet therapy
  • Embolic protection device
  • Intracoronary thrombus
  • Laser atherectomy
  • Percutaneous coronary intervention
  • Thrombus atherectomy

ASJC Scopus subject areas

  • Medicine(all)

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  • Cite this

    Karacsonyi, J., Henry, T., Ungi, I., Banerjee, S., & Brilakis, E. S. (2018). The impact of thrombus as a cause and as a result of complicated percutaneous coronary intervention. In Cardiovascular Thrombus: From Pathology and Clinical Presentations to Imaging, Pharmacotherapy and Interventions (pp. 203-216). Elsevier. https://doi.org/10.1016/B978-0-12-812615-8.00014-4