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Coronary artery thrombus as a risk factor for acute vessel occlusion during percutaneous transluminal coronary
Insights
Early percutaneous transluminal coronary angioplasty showed pre-existing coronary artery thrombus increased acute occlusion risk. Improved technology and strategies significantly reduced this risk in later procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Pre-existing coronary artery thrombus was identified as a significant risk factor for acute coronary occlusion during percutaneous transluminal coronary angioplasty (PTCA).
- Early PTCA experiences (1979-1983) indicated a 73% occlusion rate in patients with thrombus versus 8% in those without.
Purpose of the Study:
- To evaluate the impact of technological advancements and modified procedural strategies on the incidence of acute coronary occlusion in patients undergoing PTCA.
- To assess the risk of complete occlusion in patients with and without coronary artery thrombus after implementing improved techniques.
Main Methods:
- Retrospective analysis of angiograms from 297 consecutive patients undergoing PTCA (April 1983 - March 1985).
- Comparison of occlusion rates between patients with and without pre-existing coronary artery thrombus.
- Evaluation of changes in technology (steerable guiding systems) and dilatation strategy (heparinization, antiplatelet medications).
Main Results:
- In the later period, 11% of patients had coronary artery thrombus.
- Complete occlusion occurred in 24% of patients with thrombus versus 13% without thrombus.
- Despite the continued higher risk in patients with thrombus, the overall incidence of complete occlusion significantly declined compared to the earlier period.
Conclusions:
- Pre-existing coronary artery thrombus remains a risk factor for complete occlusion during PTCA.
- Technological improvements and modified dilatation strategies have significantly reduced the risk of acute coronary occlusion in patients undergoing PTCA, even in the presence of thrombus.
- Further research into managing patients with coronary artery thrombus during angioplasty is warranted.
Abstract:
Early experience with percutaneous transluminal coronary angioplasty (from October 1979 to March 1983 inclusive) showed that pre-existing coronary artery thrombus was associated with a significant increase in the incidence of acute coronary occlusion during angioplasty. Acute occlusion occurred in 11 (73%) of 15 patients with pre-existing thrombus compared with 18 (8%) of 223 patients without thrombus. The effect of improved technology (steerable guiding systems) and altered dilatation strategy (full intravenous heparinisation for 24 hours after the procedure and more intensive use of antiplatelet medications) was studied by review of angiograms from 297 consecutive patients without evidence of acute myocardial infarction who underwent angioplasty from April 1983 to March 1985 inclusive. Coronary artery thrombus was present in 34 (11%) patients, eight (24%) of whom had complete occlusion during or immediately after the procedure compared with 34 (13%) of 263 patients without thrombus. Patients with pre-existing coronary artery thrombus continue to be at greater risk of complete occlusion than patients without thrombus, but this risk has declined significantly since the modification of the angioplasty procedure.