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Intracoronary thrombus: role in coronary occlusion complicating percutaneous transluminal coronary angioplasty
Insights
Intracoronary thrombus significantly increases the risk of complete coronary artery occlusion during angioplasty. Identifying thrombus before percutaneous transluminal coronary angioplasty (PTCA) is crucial for patient risk stratification.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for treating coronary artery disease.
- Complete occlusion during or after PTCA can lead to adverse cardiac events.
- The role of intracoronary thrombus as a predictor of procedural complications requires further elucidation.
Purpose of the Study:
- To investigate the association between the presence of intracoronary thrombus before PTCA and the occurrence of complete coronary artery occlusion.
- To determine if intracoronary thrombus is an independent risk factor for procedural complications during angioplasty.
Main Methods:
- Retrospective review of angiograms from 238 consecutive patients undergoing PTCA.
- Exclusion of patients with previously occluded vessels or those receiving streptokinase therapy.
- Assessment of intracoronary thrombus presence before dilation and correlation with procedural outcomes, including complete occlusion and intimal dissection.
Main Results:
- Intracoronary thrombus was identified in 15 patients (6%) prior to dilation.
- Complete occlusion occurred in 73% of patients with pre-existing thrombus versus 8% without thrombus (p < 0.001).
- Complete occlusion in patients with thrombus was not associated with major intimal dissection, unlike in patients without thrombus.
Conclusions:
- The presence of intracoronary thrombus before PTCA is a strong predictor of complete coronary artery occlusion.
- Patients with intracoronary thrombus represent a high-risk group for procedural complications during angioplasty.
- Routine assessment for intracoronary thrombus may aid in optimizing PTCA strategies and patient management.
Abstract:
Angiograms from 238 consecutive patients who underwent percutaneous transluminal coronary angioplasty at the Mayo Clinic were reviewed to determine the presence of intracoronary thrombus before dilation. Patients with previously occluded vessels and those receiving streptokinase therapy were excluded. Intracoronary thrombus before dilation was present in 15 patients (6%); complete occlusion occurred in 11 (73%) of these during or immediately after dilation. None of these patients had angiographic evidence of major intimal dissection. In contrast, among the 223 patients in whom no intracoronary thrombus was present before dilation, complete occlusion occurred in 18 (8%) and in 12 was associated with major intimal dissection. The difference between the complete occlusion rates for patients with and without prior intracoronary thrombus was highly significant (73 versus 8%, respectively, p less than 0.001). Therefore, the presence of intracoronary thrombus identifies a group of patients who are at increased risk of developing complete occlusion during or after attempted coronary artery dilation.