Intra-coronary thrombus evolution during acute coronary syndrome: regression assessment by serial optical coherence...

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Thrombosis Research

Background:

• Acute coronary syndrome (ACS) often involves significant thrombus burden.
• Assessing thrombus regression in vivo is crucial for optimizing treatment strategies.
• Deferred stenting is a strategy used in highly thrombotic ACS cases.

Purpose of the Study:

• To investigate the feasibility of quantifying thrombus using frequency-domain optical coherence tomography (FD-OCT) in ACS patients.
• To assess the safety and efficacy of FD-OCT for monitoring thrombus regression after initial treatment.
• To evaluate the correlation between thrombus reduction and the time interval between imaging analyses.

Main Methods:

• Inclusion criteria: ACS patients with successful thrombo-aspiration and significant residual thrombus on angiography and initial FD-OCT.
• Serial FD-OCT analyses were performed to measure thrombus score, volume, and length.
• Patients underwent a second FD-OCT analysis after several days of optimal antithrombotic therapy.

Main Results:

• Sixteen ACS patients (94% STEMI) were included, with a mean follow-up of 3.9 days.
• Significant reductions in OCT-thrombus score (22.3 to 10.3), volume (9.6 to 3.6 mm³), and length (11.1 to 7.4 mm) were observed (P < 0.001).
• Thrombus reduction percentages strongly correlated with the time between FD-OCT analyses (ρ = 0.65 for score, ρ = 0.84 for volume).

Conclusions:

• FD-OCT is a feasible and safe method for thrombus quantification in selected ACS patients.
• FD-OCT enables in vivo monitoring of clot regression, offering valuable insights into treatment response.
• The study supports the use of FD-OCT for assessing thrombus burden changes over time in ACS.