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Intracoronary thrombus assessment with cardiac computed tomography angiography in a deferred stenting strategy: the

Eduardo Pozo Osinalde1,2, Teresa Bastante1, Alberto Cecconi1

  • 1Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid.

Coronary Artery Disease
|February 10, 2023
PubMed

Insights

Cardiac computed tomography angiography (CCTA) shows good agreement with angiography for thrombus detection and excellent agreement for residual stenosis in acute coronary syndrome patients. CCTA may replace repeat angiography in selected high-thrombus burden cases.

Area of Science:

  • Cardiovascular Imaging
  • Interventional Cardiology
  • Diagnostic Accuracy

Background:

  • Cardiac computed tomography angiography (CCTA) is established for coronary atherosclerosis characterization.
  • The diagnostic utility of CCTA for intracoronary thrombus remains uncertain.
  • This study addresses CCTA's role in acute coronary syndromes with high thrombus burden.

Purpose of the Study:

  • To evaluate CCTA for intracoronary thrombus and stenosis detection.
  • To assess CCTA's accuracy in patients undergoing a deferred stenting strategy.
  • To compare CCTA findings with coronary angiography and optical coherence tomography (OCT).

Main Methods:

  • Systematic CCTA performed 24 hours before repeat coronary angiography with OCT.
  • Independent, blinded evaluation of intracoronary thrombus and residual stenosis by CCTA and OCT.
  • Agreement assessed using weighted Kappa and intraclass correlation coefficients (ICC).

Main Results:

  • Thirty lesions in 28 patients were analyzed.
  • CCTA showed good concordance with angiography for thrombus detection (K=0.554) but poor agreement with OCT.
  • CCTA demonstrated excellent concordance with angiography for diameter measurement (ICC=0.85) and identified severe residual stenosis accurately.

Conclusions:

  • CCTA exhibits good concordance with angiography for intracoronary thrombus detection.
  • Excellent agreement between CCTA and angiography was observed for residual stenosis assessment.
  • CCTA may serve as a substitute for repeat angiography in selected patients with high thrombus burden.
Abstract

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