title: Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions.
abstract: OBJECTIVE
  To assess whether a strategy of invasive management without stents in selected acute coronary syndrome (ACS) patients with a large thrombus burden (LTB) might be feasible and safe.
  
  
  RESULTS
  We performed a prospective non-randomised observational cohort study of invasive treatment decisions guided by optical coherence tomography (OCT) in selected ACS patients with LTB. Among 852 ACS patients who had undergone invasive coronary angiography, 101 (11.8%) patients with large thrombus burden on initial angiography underwent thrombectomy to restore TIMI 3 flow without stenting. All of these patients then had repeat angiography with OCT (days 0-2 [Group 1], days 3-6 [Group 2] or days 7-30 [Group 3]). No adverse events occurred between the initial and second angiograms. Residual thrombus was detected in 68% of patients with OCT (respectively, 94%, 79% and 32% in Group 1, Group 2 and Group 3), and 20% of cases with angiography. Plaque rupture was detected by OCT in 65% of cases. Minimal lumen area was 2.81 mm2, 3.40 mm2 and 4.89 mm2 in Group 1, Group 2 and Group 3, respectively. Sixty-two percent of patients were stented (respectively, 76%, 61% and 50%). During a minimum follow-up period of 12 months in all patients, one non-fatal MI occurred and one PCI was performed for angina.
  
  
  CONCLUSIONS
  Medical management without stents is safe and feasible in selected ACS patients with LTB. OCT revealed culprit lesion characteristics that were not disclosed by angiography and facilitated treatment decisions.
authors.affiliation: Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.
authors.forename: Geraud
authors.initials: G
authors.lastname: Souteyrand
authors.forename: Nicolas
authors.initials: N
authors.lastname: Amabile
authors.forename: Nicolas
authors.initials: N
authors.lastname: Combaret
authors.forename: Sami
authors.initials: S
authors.lastname: Hammas
authors.forename: Francesco
authors.initials: F
authors.lastname: Prati
authors.forename: Colin
authors.initials: C
authors.lastname: Berry
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.forename: Jean-Rene
authors.initials: JR
authors.lastname: Lusson
authors.forename: Christophe
authors.initials: C
authors.lastname: Caussin
authors.forename: Pascal
authors.initials: P
authors.lastname: Motreff
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation; D058226:Plaque, Atherosclerotic; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012422:Rupture, Spontaneous; D015607:Stents; D017131:Thrombectomy / Q000009:adverse effects; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors