title: Role of a streamer-like coronary thrombus in the genesis of unstable angina.
abstract: BACKGROUND
  It is generally believed that the coronary occlusion occurs at the site of plaque disruption in acute coronary syndromes. An exceptional mechanism of coronary occlusion, namely a streamer-like thrombus (SLT) originating in a nonstenotic lesion extended distally to obstruct a just distal nondisrupted stenotic segment, was found by angioscopy in patients with unstable angina (UA). This study was carried out to examine the incidence of this phenomenon and its relationship to the subtypes of UA.
  
  
  METHODS
  The culprit coronary artery was investigated by angioscopy in successive 48 patients (mean +/- SE age, 61.0 +/- 2.3 years; 10 females and 38 males) with UA.
  
  
  RESULTS
  SLT originating in a nonstenotic lesion extended distally, and obstructed the just distal most stenotic segment (DMSS) by its tail in 11 patients (eight with class III and three with class II according to Braunwald's classification). Recurrent anginal attacks were observed in all. The nonstenotic lesion in which the SLT originated was a disrupted yellow plaque in most cases. The SLT was frequently red and yellow in a mosaic pattern, indicating a mixture of fresh thrombus and plaque debris. The plaques that constructed the DMSS were not disrupted. Angiographically, the SLT was not detectable and the entry of the DMSS showed a "tapering" configuration.
  
  
  CONCLUSIONS
  Obstruction of the DMSS by the tail of SLT originating in a nonstenotic lesion is another mechanism of UA. Therefore, treatment of both the nonstenotic lesion and DMSS is needed to prevent recurrent thrombus formation and consequent reattacks.
authors.affiliation: Japan Foundation for Cardiovascular Research, Funabashi, Japan. uchiy@ta2.so-net.ne.jp
authors.forename: Yasumi
authors.initials: Y
authors.lastname: Uchida
authors.forename: Yasuto
authors.initials: Y
authors.lastname: Uchida
authors.forename: Masahito
authors.initials: M
authors.lastname: Kanai
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sakurai
authors.forename: Tomomitsu
authors.initials: T
authors.lastname: Oshima
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Shirai
mesh_terms: D054058:Acute Coronary Syndrome / Q000473:pathology*; D000368:Aged; D000789:Angina, Unstable / Q000473:pathology*; D017546:Angioscopy; D003328:Coronary Thrombosis / Q000473:pathology*; D003331:Coronary Vessels / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged