title: Association of coronary lipid core plaque with intrastent thrombus formation: a near-infrared spectroscopy and optical coherence tomography study.
abstract: BACKGROUND
  Optical coherence tomography (OCT) and near-infrared spectroscopy (NIRS) allow assessment of the anatomy (OCT) and composition (NIRS) of coronary lesions. We sought to examine the association between pre-stenting lipid core plaque (LCP), as assessed by NIRS and post-stenting thrombus formation, as assessed by OCT.
  
  
  METHODS
  We reviewed the angiograms of nine patients who underwent coronary stenting in association with NIRS and OCT imaging. A large LCP by NIRS was defined as at least three 2-mm yellow blocks on the NIRS block chemogram with >200° angular extent. Intracoronary thrombus was defined as a mass of medium reflectivity protruding into the vessel lumen, discontinuous from the surface of the vessel wall.
  
  
  RESULTS
  Mean age was 67 ± 7 years, and all patients were men, presenting with stable angina (56%), unstable angina (11%), or acute myocardial infarction (33%). The mean vessel lipid core burden index (LCBI) was 120 ± 45, and the mean highest 6-mm LCBI was 386 ± 190. Three patients had a large LCP and two of them (66%) developed intrastent thrombus after stent implantation compared to none of six patients without large LCPs (0%, P = 0.02). The thrombus resolved after intracoronary glycoprotein IIb/IIIa administration and balloon postdilation. Postprocedural myocardial infarction occurred in 33% versus 17% of patients with and without large LCP, respectively (P = 0.57).
  
  
  CONCLUSIONS
  Stenting of large LCPs may be associated with intrastent thrombus formation, suggesting that more intensive anticoagulant and/or antiplatelet therapy may be beneficial in such lesions. © 2012 Wiley Periodicals, Inc.
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Aristotelis C
authors.initials: AC
authors.lastname: Papayannis
authors.forename: Abdul-Rahman R
authors.initials: AR
authors.lastname: Abdel-Karim
authors.forename: Arif
authors.initials: A
authors.lastname: Mahmood
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.forename: Lorenza B
authors.initials: LB
authors.lastname: Makke
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D023921:Coronary Stenosis / Q000601:surgery; D003331:Coronary Vessels / Q000737:chemistry* / Q000473:pathology; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000378:metabolism; D006801:Humans; D008055:Lipids / Q000032:analysis*; D008297:Male; D062645:Percutaneous Coronary Intervention; D058226:Plaque, Atherosclerotic / Q000737:chemistry* / Q000473:pathology; D015203:Reproducibility of Results; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D015607:Stents; D041623:Tomography, Optical Coherence / Q000379:methods*
chemical_list: D008055:Lipids