Radiofrequency-intravascular ultrasound assessment of lesion coverage after angiography-guided emergent percutaneous coronary intervention in patients with non-ST elevation myocardial infarction.
Using radiofrequency-intravascular ultrasound (VH-IVUS), we have previously demonstrated that in 50% of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention with optimal angiographic result, the stent does not fully cover the whole VH-IVUS-derived thin-cap fibroatheroma (VH-TCFA) related to the culprit lesion. Presently, we set out to extend these findings to 20 patients with non-STEMI with Thrombolysis In Myocardial Infarction flow 3 in the infarct-related artery before intervention who were then treated with angiography-guided direct stent implantation. The lesion was imaged with VH-IVUS before and after intervention, but the results were blinded to the operator. Plaque rupture site was identified in 8 lesions (40%), all proximal to the minimum lumen area (MLA) site. The maximum necrotic core site was found proximal to MLA in 18 lesions and at the MLA in 2 lesions. Although the plaque rupture site was fully covered with the stent in all lesions, an uncovered VH-TCFA was found in 7 lesions (35%), 4 in the proximal reference segment, 1 in the distal reference segment, and 2 in both the proximal and distal reference segments. In conclusion, in 35% of patients with non-STEMI undergoing angiography-guided emergent percutaneous coronary intervention, the stent does not fully cover a VH-TCFA related to the culprit lesion.
2nd Department of Cardiology, Faculty of Medicine, Jagiellonian University Medical College and University Hospital, Cracow, Poland.
Jacek
J
Legutko
Jacek
J
Jakala
Gary S
GS
Mintz
Grzegorz L
GL
Kaluza
Blaz
B
Mrevlje
Lukasz
L
Partyka
Marcin
M
Wizimirski
Lukasz
L
Rzeszutko
Angela
A
Richter
Pauliina
P
Margolis
Dariusz
D
Dudek
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D009336:Necrosis; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D012421:Rupture; D015607:Stents; D018084:Ultrasonography, Interventional / Q000379:methods