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[The results of percutaneous transluminal coronary angioplasty in lesions with thrombi]
F Alfonso1, C Macaya, A Iñiguez
1Departamento de Cardiopulmonar, Hospital Clínico Universitario, Madrid.
Insights
Coronary angioplasty outcomes are similar for lesions with and without thrombus when total occlusions are excluded. Lesions with thrombus often have complex features, impacting initial success rates but not long-term results.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary angioplasty outcomes may be affected by the presence of intracoronary thrombus.
- Thrombus-associated lesions present unique challenges during percutaneous coronary intervention.
Purpose of the Study:
- To prospectively assess the impact of intracoronary thrombus on the success and outcomes of coronary angioplasty.
- To compare angioplasty results in lesions with and without thrombus.
Main Methods:
- Prospective analysis of 1,192 consecutive coronary lesions undergoing angioplasty.
- Comparison of lesions with angiographic evidence of thrombus (Group I, n=88) versus those without (Group II, n=1,104).
- Evaluation of lesion characteristics, procedural success, and early reocclusion rates.
Main Results:
- Lesions with thrombus were more frequently associated with acute myocardial infarction, total occlusions, and complex angiographic features (severity, eccentricity, irregularity).
- Primary angiographic success was lower in the thrombus group (79% vs 92%), with higher rates of luminal irregularities and early reocclusion.
- Excluding total occlusions, primary angiographic success rates were similar between groups (90% vs 91%).
Conclusions:
- Intracoronary thrombus is often associated with unfavorable angiographic characteristics that can complicate angioplasty.
- Coronary angioplasty results for thrombus-containing lesions are comparable to non-thrombus lesions when totally occluded vessels are excluded.
Abstract:
Previous studies have suggested that the results of coronary angioplasty are poorer when the attempted lesion has a thrombus associated. With the aim of assessing the results of coronary angioplasty in lesions with thrombus, 1,192 consecutive coronary lesions attempted were prospectively analyzed. Of these, 88 (7%) had associated an angiographic intraluminal filling defect consistent with thrombus (group I) and were compared with the remaining 1,104 lesions (93%) without thrombus (group II). Age (56 +/- 12 vs 59 +/- 10 years) was similar in both groups, but patients in group I required more frequently dilatation after a myocardial infarction (acute phase or following thrombolytic therapy) (36% vs 12%, p less than 0.005) but infrequently for stable angina (6% vs 21%, p less than 0.005). Left ventricular ejection fraction (60 +/- 13% vs 63 +/- 12%) and the number of diseased vessels (1.46 +/- 0.7 vs 1.58 +/- 0.8) were similar in groups I and II, respectively, but lesions in group I were less frequently located in the left anterior descending coronary artery (35% vs 53%, p less than 0.025). Furthermore, lesions in group I were more frequently total occlusions (35% vs 4%, p less than 0.001), and were more severe (94 +/- 6% vs 87 +/- 8%, p less than 0.005), eccentric (81% vs 54%, p less than 0.005), irregular (72% vs 32%, p less than 0.005) and more frequently located at bend points (31% vs 17%, p less than 0.05). Primary angiographic success was lower in group I (79% vs 92%, p less than 0.001) and, after dilatation, the incidence of luminal irregularities (34% vs 15%, p less than 0.001) and early reocclusion (10% vs 1%, p less than 0.05) was higher in this group. However, when patients presenting with total occlusions were excluded from both groups primary angiographic success was similar (90% vs 91%) for groups I and II, respectively. We conclude that: 1) Lesions with intracoronary thrombus usually present other unfavourable angiographic characteristics for dilatation. 2) Results of coronary angioplasty in lesions with thrombus are similar to those obtained in other lesions when totally occluded vessels are excluded.