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 language | English (US) |
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Title of host publication | Cardiovascular Thrombus |
Subtitle of host publication | From Pathology and Clinical Presentations to Imaging, Pharmacotherapy and Interventions |
Publisher | Elsevier |
Pages | 203-216 |
Number of pages | 14 |
ISBN (Electronic) | 9780128126158 |
ISBN (Print) | 9780128126165 |
DOIs | |
State | Published - Jan 1 2018 |
Keywords
- Anticoagulation
- Antiplatelet therapy
- Embolic protection device
- Intracoronary thrombus
- Laser atherectomy
- Percutaneous coronary intervention
- Thrombus atherectomy
ASJC Scopus subject areas
- General Medicine