OCT Findings in Patients With Recanalization of Organized Thrombi in Coronary Arteries
OCT Findings in Patients With Recanalization of Organized Thrombi in Coronary Arteries
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DOI：
10.1016/j.jcmg.2012.03.012
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发表时间：
2012-07-01
影响因子：
14
通讯作者：
Park, Seung-Jung
中科院分区：
文献类型：
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作者：
Kang, Soo-Jin;Nakano, Masataka;Park, Seung-Jung
目的本研究的目的是确定冠状动脉病变合并血栓再通的血管造影和光学相干断层扫描（OCT）特征。背景：虽然病理上有血栓自发再通的报道，但在临床实践中很少得到认可。结果6例患者血栓再通，男3例，女3例，中位年龄63岁，年龄54 ~ 72岁。根据症状诊断为不稳定型心绞痛3例；2例诊断为稳定型心绞痛；1例有二尖瓣狭窄和巨大左心房血栓，被诊断为梗死后心绞痛。所有患者入院时血清心脏标志物浓度正常。血管造影显示不规则线状充盈缺损及模糊。2例接近完全闭塞的患者有心肌梗死溶栓（TIMI）血流1级和侧络，而4例患者有TIMI血流3级和无侧络。所有患者的OCT表现均与再通血栓一致，血栓由信号丰富的高反向散射间隔组成，将管腔划分为多个相互连通的小腔。这些结构具有光滑的内部边界，创造了“瑞士奶酪”的外观。经皮冠状动脉介入治疗5例经有创或无创应激试验证实的血管造影慢血流或诱导性缺血患者。其余1例冠脉血流恢复的患者行二尖瓣手术和左房血栓切除术。结论：OCT提供了慢性全闭塞和次全狭窄血栓组织特征的详细信息。含有再通血栓的冠状动脉病变以多个小通道为特征，多数具有功能意义。[J] journal of Cardiology, 2012;5:725-32] (C) 2012
OBJECTIVES The purpose of this study was to determine the angiographic and optical coherence tomographic (OCT) characteristics of coronary lesions with recanalized thrombi.BACKGROUND Although spontaneous recanalization of thrombi has been reported pathologically, it is rarely recognized in clinical practice.METHODS Based on histopathologic features, recanalization of thrombi was defined by characteristics on OCT.RESULTS Recanalization of thrombi was identified in 6 patients (3 male, 3 female; median age 63 years; age range 54 to 72 years). Based on symptoms, 3 patients were diagnosed with unstable angina; 2 were diagnosed with stable angina; and 1, who had mitral stenosis and huge left atrial thrombi, was diagnosed with post-infarct angina. All had normal serum concentrations of cardiac markers at admission. Angiography showed irregular linear filling defects and haziness. Two patients with near total occlusion had Thrombolysis In Myocardial Infarction (TIMI) flow grade 1 and collaterals, whereas 4 patients had TIMI flow grade 3 and no collaterals. All patients showed OCT findings consistent with recanalized thrombi, which consisted of signal-rich, high backscattered septa that divided the lumen into multiple small cavities communicating with each other. These structures, which had smooth inner borders, created a "Swiss cheese" appearance. Percutaneous coronary intervention was performed in 5 patients with angiographic slow flow or inducible-ischemia as documented by invasive or noninvasive stress tests. The remaining 1 patient with restored coronary flow underwent mitral valve surgery and left atrial thrombectomy.CONCLUSIONS OCT provided details on the characteristics of the organization of thrombi in both chronic total occlusion and subtotal narrowing. Coronary lesions containing recanalized thrombi were characterized by multiple small channels, with most showing functional significance. (J Am Coll Cardiol Img 2012;5:725-32) (C) 2012 by the American College of Cardiology Foundation