Optical coherence tomography guided in-stent thrombus removal in patients with acute coronary syndromes
The persistence of thrombus inside stent struts is a frequent event in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI), and this phenomenon might be associated with an increased risk of stent thrombosis. We sought to quantify by means of optical coher...
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| Veröffentlicht in: | The International Journal of Cardiovascular Imaging 2013-06, Vol.29 (5), p.989-996 |
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| creator | Di Giorgio, Alessandro Capodanno, Davide Ramazzotti, Vito Imola, Fabrizio Mallus, Maria Teresa Stazi, Filippo Paoletti, Giulia Biondi-Zoccai, Giuseppe Tamburino, Corrado Prati, Francesco |
| description | The persistence of thrombus inside stent struts is a frequent event in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI), and this phenomenon might be associated with an increased risk of stent thrombosis. We sought to quantify by means of optical coherence tomography (OCT) the presence of in-stent thrombus after achievement of an optimal angiographic result in patients with ACS undergoing PCI. In addition, we evaluated the feasibility and safety of an OCT-guided strategy of in-stent thrombus removal. Eighty consecutive patients with ACS undergoing PCI were treated with two different strategies equally divided into two groups: angio-guided PCI, and OCT-guided PCI, in which additional OCT-driven in-stent balloon dilatation was adopted to reduce thrombus encroachment of the lumen. Overall in-stent thrombus area was 4.3 % with a maximal thrombus encroachment of 16.7 %. In the OCT-guided group, use of high pressure intra-stent dilatation led to a significant increase in stented area (9.6 ± 2.4 vs. 9.1 ± 2.49 mm
2
,
p
= 0.002) and lumen area (9.2 ± 2.4 vs. 8.7 ± 2.3 mm
2
,
p
|
| doi_str_mv | 10.1007/s10554-013-0191-0 |
| format | Article |
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2
,
p
= 0.002) and lumen area (9.2 ± 2.4 vs. 8.7 ± 2.3 mm
2
,
p
< 0.001) and also significantly decreased in-stent thrombus area in absolute (0.35 ± 0.29 vs. 0.42 ± 0.30 mm
2
,
p
= 0.001) and relative terms (3.58 ± 3.25 vs. 4.53 ± 3.01 %,
p
= 0.001). Values of TIMI flow, frame count and blush grade, as well as clinical outcomes were not detrimentally affected by such additional dilatations. The use of additional OCT-driven in-stent balloon dilatations is feasible, safe and might be effective in the treatment of in-stent thrombus for patients with ACS.</description><identifier>ISSN: 1569-5794</identifier><identifier>EISSN: 1573-0743</identifier><identifier>EISSN: 1875-8312</identifier><identifier>DOI: 10.1007/s10554-013-0191-0</identifier><identifier>PMID: 23412883</identifier><identifier>CODEN: IJCIBI</identifier><language>eng</language><publisher>Dordrecht: Springer Netherlands</publisher><subject>Acute Coronary Syndrome - diagnostic imaging ; Acute Coronary Syndrome - etiology ; Acute Coronary Syndrome - pathology ; Acute Coronary Syndrome - therapy ; Aged ; Angioplasty, Balloon, Coronary - adverse effects ; Angioplasty, Balloon, Coronary - instrumentation ; Cardiac Imaging ; Cardiology ; Chi-Square Distribution ; Coronary Angiography ; Coronary Thrombosis - complications ; Coronary Thrombosis - diagnostic imaging ; Coronary Thrombosis - pathology ; Coronary Thrombosis - therapy ; Coronary Vessels - diagnostic imaging ; Coronary Vessels - pathology ; Feasibility Studies ; Female ; Humans ; Imaging ; Linear Models ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Multivariate Analysis ; Original Paper ; Predictive Value of Tests ; Radiology ; Stents ; Thrombectomy - adverse effects ; Time Factors ; Tomography, Optical Coherence ; Treatment Outcome</subject><ispartof>The International Journal of Cardiovascular Imaging, 2013-06, Vol.29 (5), p.989-996</ispartof><rights>Springer Science+Business Media Dordrecht 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-73306d819259fdec7995f26b42f124aa62f37b5bbf5660b9745aa018eace64523</citedby><cites>FETCH-LOGICAL-c372t-73306d819259fdec7995f26b42f124aa62f37b5bbf5660b9745aa018eace64523</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10554-013-0191-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10554-013-0191-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23412883$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Di Giorgio, Alessandro</creatorcontrib><creatorcontrib>Capodanno, Davide</creatorcontrib><creatorcontrib>Ramazzotti, Vito</creatorcontrib><creatorcontrib>Imola, Fabrizio</creatorcontrib><creatorcontrib>Mallus, Maria Teresa</creatorcontrib><creatorcontrib>Stazi, Filippo</creatorcontrib><creatorcontrib>Paoletti, Giulia</creatorcontrib><creatorcontrib>Biondi-Zoccai, Giuseppe</creatorcontrib><creatorcontrib>Tamburino, Corrado</creatorcontrib><creatorcontrib>Prati, Francesco</creatorcontrib><title>Optical coherence tomography guided in-stent thrombus removal in patients with acute coronary syndromes</title><title>The International Journal of Cardiovascular Imaging</title><addtitle>Int J Cardiovasc Imaging</addtitle><addtitle>Int J Cardiovasc Imaging</addtitle><description>The persistence of thrombus inside stent struts is a frequent event in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI), and this phenomenon might be associated with an increased risk of stent thrombosis. We sought to quantify by means of optical coherence tomography (OCT) the presence of in-stent thrombus after achievement of an optimal angiographic result in patients with ACS undergoing PCI. In addition, we evaluated the feasibility and safety of an OCT-guided strategy of in-stent thrombus removal. Eighty consecutive patients with ACS undergoing PCI were treated with two different strategies equally divided into two groups: angio-guided PCI, and OCT-guided PCI, in which additional OCT-driven in-stent balloon dilatation was adopted to reduce thrombus encroachment of the lumen. Overall in-stent thrombus area was 4.3 % with a maximal thrombus encroachment of 16.7 %. In the OCT-guided group, use of high pressure intra-stent dilatation led to a significant increase in stented area (9.6 ± 2.4 vs. 9.1 ± 2.49 mm
2
,
p
= 0.002) and lumen area (9.2 ± 2.4 vs. 8.7 ± 2.3 mm
2
,
p
< 0.001) and also significantly decreased in-stent thrombus area in absolute (0.35 ± 0.29 vs. 0.42 ± 0.30 mm
2
,
p
= 0.001) and relative terms (3.58 ± 3.25 vs. 4.53 ± 3.01 %,
p
= 0.001). Values of TIMI flow, frame count and blush grade, as well as clinical outcomes were not detrimentally affected by such additional dilatations. The use of additional OCT-driven in-stent balloon dilatations is feasible, safe and might be effective in the treatment of in-stent thrombus for patients with ACS.</description><subject>Acute Coronary Syndrome - diagnostic imaging</subject><subject>Acute Coronary Syndrome - etiology</subject><subject>Acute Coronary Syndrome - pathology</subject><subject>Acute Coronary Syndrome - therapy</subject><subject>Aged</subject><subject>Angioplasty, Balloon, Coronary - adverse effects</subject><subject>Angioplasty, Balloon, Coronary - instrumentation</subject><subject>Cardiac Imaging</subject><subject>Cardiology</subject><subject>Chi-Square Distribution</subject><subject>Coronary Angiography</subject><subject>Coronary Thrombosis - complications</subject><subject>Coronary Thrombosis - diagnostic imaging</subject><subject>Coronary Thrombosis - pathology</subject><subject>Coronary Thrombosis - therapy</subject><subject>Coronary Vessels - diagnostic imaging</subject><subject>Coronary Vessels - pathology</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Humans</subject><subject>Imaging</subject><subject>Linear Models</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Original Paper</subject><subject>Predictive Value of Tests</subject><subject>Radiology</subject><subject>Stents</subject><subject>Thrombectomy - adverse effects</subject><subject>Time Factors</subject><subject>Tomography, Optical Coherence</subject><subject>Treatment Outcome</subject><issn>1569-5794</issn><issn>1573-0743</issn><issn>1875-8312</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kU9r3DAQxUVIadK0HyCXIMglF7ejf5Z1LKFNC4Fc2rOQ5fGuw1pyJblhv321bFJKoAchDfN7byQ9Qi4ZfGQA-lNmoJRsgIm6DGvghJwzpWulpTg9nFvTKG3kGXmX8yMAcODiLTnjQjLedeKcbB6WMnm3oz5uMWHwSEuc4ya5Zbunm3UacKBTaHLBUGjZpjj3a6YJ5_i7qqZAF1em2sv0aSpb6vxasJqlGFza07wPQ5Vgfk_ejG6X8cPzfkF-fv3y4_Zbc_9w9_32833jheal0UJAO3TMcGXGAb02Ro287SUfGZfOtXwUuld9P6q2hd5oqZwD1qHz2ErFxQW5OfouKf5aMRc7T9njbucCxjVbJkwnuaxzKnr9Cn2Mawr1dpXqQIJQsq0UO1I-xZwTjnZJ01zfZhnYQwr2mIKtKdhDChaq5urZee1nHP4qXr69AvwI5NoKG0z_jP6v6x_0DZLR</recordid><startdate>20130601</startdate><enddate>20130601</enddate><creator>Di Giorgio, Alessandro</creator><creator>Capodanno, Davide</creator><creator>Ramazzotti, Vito</creator><creator>Imola, Fabrizio</creator><creator>Mallus, Maria Teresa</creator><creator>Stazi, Filippo</creator><creator>Paoletti, Giulia</creator><creator>Biondi-Zoccai, Giuseppe</creator><creator>Tamburino, Corrado</creator><creator>Prati, Francesco</creator><general>Springer Netherlands</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20130601</creationdate><title>Optical coherence tomography guided in-stent thrombus removal in patients with acute coronary syndromes</title><author>Di Giorgio, Alessandro ; Capodanno, Davide ; Ramazzotti, Vito ; Imola, Fabrizio ; Mallus, Maria Teresa ; Stazi, Filippo ; Paoletti, Giulia ; Biondi-Zoccai, Giuseppe ; Tamburino, Corrado ; Prati, Francesco</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-73306d819259fdec7995f26b42f124aa62f37b5bbf5660b9745aa018eace64523</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Acute Coronary Syndrome - diagnostic imaging</topic><topic>Acute Coronary Syndrome - etiology</topic><topic>Acute Coronary Syndrome - pathology</topic><topic>Acute Coronary Syndrome - therapy</topic><topic>Aged</topic><topic>Angioplasty, Balloon, Coronary - adverse effects</topic><topic>Angioplasty, Balloon, Coronary - instrumentation</topic><topic>Cardiac Imaging</topic><topic>Cardiology</topic><topic>Chi-Square Distribution</topic><topic>Coronary Angiography</topic><topic>Coronary Thrombosis - complications</topic><topic>Coronary Thrombosis - diagnostic imaging</topic><topic>Coronary Thrombosis - pathology</topic><topic>Coronary Thrombosis - therapy</topic><topic>Coronary Vessels - diagnostic imaging</topic><topic>Coronary Vessels - pathology</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Humans</topic><topic>Imaging</topic><topic>Linear Models</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Original Paper</topic><topic>Predictive Value of Tests</topic><topic>Radiology</topic><topic>Stents</topic><topic>Thrombectomy - adverse effects</topic><topic>Time Factors</topic><topic>Tomography, Optical Coherence</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Di Giorgio, Alessandro</creatorcontrib><creatorcontrib>Capodanno, Davide</creatorcontrib><creatorcontrib>Ramazzotti, Vito</creatorcontrib><creatorcontrib>Imola, Fabrizio</creatorcontrib><creatorcontrib>Mallus, Maria Teresa</creatorcontrib><creatorcontrib>Stazi, Filippo</creatorcontrib><creatorcontrib>Paoletti, Giulia</creatorcontrib><creatorcontrib>Biondi-Zoccai, Giuseppe</creatorcontrib><creatorcontrib>Tamburino, Corrado</creatorcontrib><creatorcontrib>Prati, Francesco</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>The International Journal of Cardiovascular Imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Di Giorgio, Alessandro</au><au>Capodanno, Davide</au><au>Ramazzotti, Vito</au><au>Imola, Fabrizio</au><au>Mallus, Maria Teresa</au><au>Stazi, Filippo</au><au>Paoletti, Giulia</au><au>Biondi-Zoccai, Giuseppe</au><au>Tamburino, Corrado</au><au>Prati, Francesco</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Optical coherence tomography guided in-stent thrombus removal in patients with acute coronary syndromes</atitle><jtitle>The International Journal of Cardiovascular Imaging</jtitle><stitle>Int J Cardiovasc Imaging</stitle><addtitle>Int J Cardiovasc Imaging</addtitle><date>2013-06-01</date><risdate>2013</risdate><volume>29</volume><issue>5</issue><spage>989</spage><epage>996</epage><pages>989-996</pages><issn>1569-5794</issn><eissn>1573-0743</eissn><eissn>1875-8312</eissn><coden>IJCIBI</coden><abstract>The persistence of thrombus inside stent struts is a frequent event in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI), and this phenomenon might be associated with an increased risk of stent thrombosis. We sought to quantify by means of optical coherence tomography (OCT) the presence of in-stent thrombus after achievement of an optimal angiographic result in patients with ACS undergoing PCI. In addition, we evaluated the feasibility and safety of an OCT-guided strategy of in-stent thrombus removal. Eighty consecutive patients with ACS undergoing PCI were treated with two different strategies equally divided into two groups: angio-guided PCI, and OCT-guided PCI, in which additional OCT-driven in-stent balloon dilatation was adopted to reduce thrombus encroachment of the lumen. Overall in-stent thrombus area was 4.3 % with a maximal thrombus encroachment of 16.7 %. In the OCT-guided group, use of high pressure intra-stent dilatation led to a significant increase in stented area (9.6 ± 2.4 vs. 9.1 ± 2.49 mm
2
,
p
= 0.002) and lumen area (9.2 ± 2.4 vs. 8.7 ± 2.3 mm
2
,
p
< 0.001) and also significantly decreased in-stent thrombus area in absolute (0.35 ± 0.29 vs. 0.42 ± 0.30 mm
2
,
p
= 0.001) and relative terms (3.58 ± 3.25 vs. 4.53 ± 3.01 %,
p
= 0.001). Values of TIMI flow, frame count and blush grade, as well as clinical outcomes were not detrimentally affected by such additional dilatations. The use of additional OCT-driven in-stent balloon dilatations is feasible, safe and might be effective in the treatment of in-stent thrombus for patients with ACS.</abstract><cop>Dordrecht</cop><pub>Springer Netherlands</pub><pmid>23412883</pmid><doi>10.1007/s10554-013-0191-0</doi><tpages>8</tpages></addata></record> |
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| identifier | ISSN: 1569-5794 |
| ispartof | The International Journal of Cardiovascular Imaging, 2013-06, Vol.29 (5), p.989-996 |
| issn | 1569-5794 1573-0743 1875-8312 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Acute Coronary Syndrome - diagnostic imaging Acute Coronary Syndrome - etiology Acute Coronary Syndrome - pathology Acute Coronary Syndrome - therapy Aged Angioplasty, Balloon, Coronary - adverse effects Angioplasty, Balloon, Coronary - instrumentation Cardiac Imaging Cardiology Chi-Square Distribution Coronary Angiography Coronary Thrombosis - complications Coronary Thrombosis - diagnostic imaging Coronary Thrombosis - pathology Coronary Thrombosis - therapy Coronary Vessels - diagnostic imaging Coronary Vessels - pathology Feasibility Studies Female Humans Imaging Linear Models Male Medicine Medicine & Public Health Middle Aged Multivariate Analysis Original Paper Predictive Value of Tests Radiology Stents Thrombectomy - adverse effects Time Factors Tomography, Optical Coherence Treatment Outcome |
| title | Optical coherence tomography guided in-stent thrombus removal in patients with acute coronary syndromes |
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