The management of thrombotic lesions in the cardiac catheterization laboratory.
Plaque rupture with superimposed thrombosis is the major mechanism of acute coronary syndromes. Although angiography underestimates the presence of thrombi, their detection is a poor prognostic indicator which is proportional to their size. Although emergent percutaneous coronary intervention (PCI) in the setting of ST elevation myocardial infarction (STEMI) and early PCI in the setting of unstable angina and non-STEMI were shown to be preferred strategies, the presence of angiographic thrombosis by virtue of causing micro and macro embolization can reduce the benefit of the intervention. Antiplatelet therapy especially using glycoprotein IIb/IIIa inhibitors reduces thrombus size, and improves myocardial perfusion and ventricular function. Routine manual aspiration prior to PCI in STEMI also improves myocardial flow and reduces distal embolization and improves survival. Distal embolic protection devices and mechanical thrombectomy do not have the same clinical benefits however, rheolytic thrombectomy may have a role in large vessels with a large thrombi.
Tampa General Hospital, Tampa, FL 33609, USA. fmatar@me.com
Fadi
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Matar
Jad
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Mroue
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D057505:Embolic Protection Devices; D019317:Evidence-Based Medicine; D006801:Humans; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D015995:Prevalence; D013396:Suction; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors