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Updated: Aug 8, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Pre-stenting residual thrombotic volume assessed by dual quantitative coronary angiography predicts microvascular
Rocco Vergallo1,2, Marco Lombardi3, Giorgos Besis3
1Cardiothoracic and Vascular Department (DICATOV), IRCCS San Martino Hospital, Genoa, Italy - rocco.vergallo@unige.it.
Background:
Microvascular obstruction (MVO) is a frequent occurrence after primary percutaneous coronary intervention (pPCI), and is associated with adverse left ventricular remodeling and worse clinical outcome. Distal embolization of thrombotic material is one of the most important underlying mechanisms. The aim of this study was to investigate the relation between the thrombotic volume evaluated by dual quantitative coronary angiography (QCA) prior to stenting and the occurrence of MVO as assessed by cardiac magnetic resonance (CMR).
Methods:
Forty-eight patients with ST-segment elevation myocardial infarction (STEMI) undergoing pPCI and receiving CMR within 7 days from admission were included. Pre-stenting residual thrombus volume at the site of the culprit lesion was measured by applying automated edge detection and video-assisted densitometry techniques (i.e., dual-QCA), and patients were categorized into tertiles of thrombus volume. The presence of delayed-enhancement MVO, as well as its extent (MVO mass), were assessed by CMR.
Results:
Pre-stenting dual-QCA thrombus volume was significantly greater in patients with MVO than in those without (5.85 mm3 [2.05-16.71] vs. 1.88 mm3 [1.03-6.92], P=0.009). Patients in the highest tertile showed greater MVO mass compared to those in the mid and lowest tertiles (113.3 gr [0.0-203.8] vs. 58.5 g [0.00-144.4] vs. 0.0 g [0.0-60.225], respectively; P=0.031). The best cut-off value of dual-QCA thrombus volume for prediction of MVO was 2.07 mm3 (AUC: 0.720). The addition of dual-QCA thrombus volume to the traditional angiographic indices of no-reflow enhanced the prediction of MVO by CMR (R=0.752).
Conclusions:
Pre-stenting dual-QCA thrombus volume is associated with the presence and extent of MVO detected by CMR in patients with STEMI. This methodology may aid the identification of patients at higher risk of MVO and guide adoption of preventive strategies.
Insights
Dual quantitative coronary angiography (QCA) can measure pre-stenting thrombus volume, identifying patients at higher risk of microvascular obstruction (MVO) after ST-segment elevation myocardial infarction (STEMI) treatment. This aids in adopting preventive strategies to improve outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Imaging
Background:
- Microvascular obstruction (MVO) frequently occurs post-primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI) patients.
- Distal embolization of thrombotic material is a key mechanism contributing to MVO.
- MVO is linked to adverse left ventricular remodeling and poorer clinical outcomes.
Purpose of the Study:
- To investigate the relationship between pre-stenting thrombotic volume, measured by dual quantitative coronary angiography (QCA), and the occurrence of MVO.
- To assess MVO using cardiac magnetic resonance (CMR) imaging.
- To determine if dual-QCA thrombus volume can predict MVO in STEMI patients undergoing pPCI.
Main Methods:
- Forty-eight STEMI patients undergoing pPCI and CMR within 7 days were included.
- Pre-stenting residual thrombus volume was quantified using dual-QCA (automated edge detection and video-assisted densitometry).
- Patients were stratified into tertiles based on thrombus volume; MVO presence and extent (MVO mass) were assessed by CMR.
Main Results:
- Significantly greater pre-stenting dual-QCA thrombus volume was observed in patients with MVO compared to those without (5.85 mm³ vs. 1.88 mm³).
- Patients in the highest thrombus volume tertile exhibited greater MVO mass (113.3 g) than those in the mid (58.5 g) and lowest (0.0 g) tertiles.
- Dual-QCA thrombus volume (cut-off 2.07 mm³, AUC 0.720) improved MVO prediction when added to traditional no-reflow indices (R=0.752).
Conclusions:
- Pre-stenting dual-QCA thrombus volume is significantly associated with the presence and extent of MVO detected by CMR in STEMI patients.
- This quantitative imaging method can identify patients at higher risk for MVO.
- Findings suggest dual-QCA can guide the adoption of preventive strategies to mitigate MVO.
