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Combined Near-infrared Fluorescent Imaging and Micro-computed Tomography for Directly Visualizing Cerebral Thromboemboli
Published on: September 25, 2016
[Coronary thrombosis imaging in humans]
J M Lablanche1, G Perrard, A Chmait
1Service de cardiologie B et hémodynamique, hôpital cardiologique, boulevard du Pr-Leclercq, 59037 Lille.
Insights
Identifying coronary thrombosis is crucial for patient outcomes. While angioscopy offers high sensitivity, its complexity limits use. Coronary angiography provides indirect evidence, and future MRI may aid detection.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Coronary thrombosis identification impacts prognosis and treatment.
- Invasive techniques like angioscopy, coronarography, and endocoronary ultrasound are used for diagnosis.
- Understanding the diagnostic capabilities and limitations of each technique is essential.
Purpose of the Study:
- To review the diagnostic utility of various invasive techniques for coronary thrombosis.
- To compare the sensitivity and specificity of angioscopy, coronarography, and endocoronary ultrasound.
- To discuss the potential future role of magnetic resonance imaging.
Main Methods:
- Review of existing literature on diagnostic techniques for coronary thrombosis.
- Analysis of sensitivity and specificity data for angioscopy and coronarography.
- Discussion of limitations of endocoronary ultrasound and potential of MRI.
Main Results:
- Angioscopy demonstrates high sensitivity for thrombus detection (67% unstable angina, 75% myocardial infarction).
- Coronarography offers good specificity but lower sensitivity for coronary thrombosis.
- Endocoronary ultrasound struggles with fresh, non-echogenic thrombus and differentiating old thrombus from plaque.
Conclusions:
- Angioscopy is sensitive but complex; coronarography is specific but less sensitive for coronary thrombosis.
- Current invasive methods have limitations in accurately detecting and characterizing coronary thrombus.
- Magnetic resonance imaging shows promise for future non-invasive detection of recent coronary thrombus.
Abstract:
The identification of coronary thrombosis in humans has important prognostic and therapeutic implications. Its recognition calls for invasive techniques: angioscopy, coronarography, and endocoronary ultrasound. Angioscopy allows visualisation of the arterial surface and the detection of thrombus with great sensitivity. Its presence is exclusive to the acute coronary syndromes: 67% in unstable angina, and 75% in myocardial infarction, although it is only present in 27% of cases of stable angina. The relative complexity of its use has led to the abandonment of this technique. Coronarography allows an indirect approach to coronary thrombosis. Certain aspects are evocative such as: intraluminal filling defect, complete occlusion with upstream convexity, ulceration and eccentric type 2 Ambrose classification plaques. As a function of the clinical presentation, the coronarographic views allow a good specificity for the diagnosis of thrombus. The sensitivity is weak, however, compared to angioscopy. Endocoronary ultrasound does not allow identification of fresh thrombus which is not echogenic and does not allow differentiation between older thrombus and lipid plaque. In the future, magnetic resonance imaging could prove interesting in the detection of recent thrombus.
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