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Culprit lesion plaque characterization and thrombus grading by high-definition intravascular ultrasound in patients

Frederik T W Groenland1, Annemieke C Ziedses des Plantes1, Tara Neleman1

  • 1Department of (Interventional) Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|May 26, 2023
PubMed

Insights

High-definition intravascular ultrasound (HD-IVUS) effectively characterizes culprit lesions and thrombus in ST-segment elevation myocardial infarction (STEMI) patients, aiding in personalized percutaneous coronary intervention (PCI) strategies.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Interventional Cardiology

Background:

  • Prospective studies on high-definition intravascular ultrasound (HD-IVUS)-guided primary percutaneous coronary intervention (PCI) are limited.
  • Understanding culprit lesion plaque and thrombus characteristics is crucial for optimizing STEMI treatment.

Purpose of the Study:

  • To qualify and quantify culprit lesion plaque characteristics and thrombus using HD-IVUS in STEMI patients.
  • To assess the utility of HD-IVUS in guiding primary PCI for STEMI.

Main Methods:

  • The SPECTRUM study is a prospective, observational cohort study of 200 STEMI patients.
  • HD-IVUS imaging was performed pre-PCI on the first 100 patients to analyze plaque and thrombus.
  • An IVUS-derived thrombus score was developed to assess thrombus burden.

Main Results:

  • Thrombus was observed in 91% of patients, with high thrombus burden in 40.7%.
  • High thrombus burden was significantly associated with impaired final myocardial infarction flow (27.0% vs. 1.9%).
  • Plaque rupture was identified in 48% of patients.

Conclusions:

  • HD-IVUS provides detailed plaque characterization and thrombus grading in STEMI patients.
  • These detailed assessments may guide the development of tailored PCI strategies.
  • HD-IVUS imaging can enhance the understanding and management of STEMI.
Abstract

Keywords:
ST-segment elevation myocardial infarctionintravascular ultrasoundthrombus

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