Myocardial infarction with non-obstructive thrombus validated by optical coherence tomography.
OBJECTIVE
Coronary angiography provides no details on underlying pathology in acute coronary syndromes (ACS). Optical coherence tomography (OCT) can visualize coronary atherosclerosis, thrombus formation, and plaque rupture in patients with myocardial infarction (MI) where coronary angiography is unclear.


METHODS
We present a case series containing six young patients with ACS, four of them due to non-obstructive thrombus, in whom the operators refrained from stent implantation despite an identifiable culprit lesion with OCT-validated thrombus formation.


RESULTS
The median age was 31.5 years. In four of these six patients, no invasive intervention was performed while the remaining two patients underwent thrombus aspiration and balloon angioplasty without stent implantation. Four patients were examined at the primary evaluation and all patients were examined by OCT between 3-5 days after initial examination. This short-term follow-up with OCT showed non-obstructive thrombus formation in all patients with varying degrees of thrombus resolution. No adverse cardiac events were reported after a median follow up of 5.5 months.


CONCLUSIONS
OCT can visualize thrombus formation in young ACS patients with non-obstructive thrombus or following thrombus reduction by aspiration and balloon dilatation. These patients seems safely treated with a conservative medical approach rather than with stent implantation.
a Department of Cardiology , Aarhus University Hospital , Aarhus , Denmark.
Kevin Kris Warnakula
KK
Olesen
a Department of Cardiology , Aarhus University Hospital , Aarhus , Denmark.
Trine
T
Ørhøj Barkholt
a Department of Cardiology , Aarhus University Hospital , Aarhus , Denmark.
Michael
M
Maeng
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D000328:Adult; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D000072658:Non-ST Elevated Myocardial Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D017131:Thrombectomy; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
Myocardial infarction; coronary angiography; dual antiplatelet treatment; non-obstructive thrombus; optical coherence tomography