title: The role of residual intrastent thrombus during primary angioplasty: insights from the COCTAIL II study.
abstract: OBJECTIVE
  Recent frequency-domain optical coherence tomography studies showed that a complete removal of thrombotic materials is rarely achieved after percutaneous coronary interventions for ST segment elevation myocardial infarction. Residual intrastent thrombus can embolize distally leading to microcirculatory injury. The aim was to find a possible correlation between residual intrastent thrombus and angiographic indexes of myocardial reperfusion.
  
  
  METHODS
  The population consisted of 128 ST segment elevation myocardial infarction patients enrolled in the COCTAIL II trial. Intrastent thrombus at optical coherence tomography was defined as the maximum percentage value of thrombus area (thrombus area/stent area × 100 in the cross-section with largest thrombus). A thrombus area of at least 16% (mean value) was considered indicative of high residual intrastent thrombus. The following angiographic indexes of myocardial reperfusion were evaluated: thrombolysis in myocardial infarction (TIMI) value, corrected TIMI frame count and myocardial blush grade.
  
  
  RESULTS
  Angiographic and optical coherence tomography results are available in 119 patients: 64 had a maximum percentage value of thrombus area less than 16%, whereas the remaining 55 had a residual intrastent thrombus at least 16%. No differences were found regarding the microcirculatory indexes at baseline angiogram. After intervention, patients with intrastent thrombus less than 16% showed a significant improvement in the final TIMI value (2.87 ± 0.33 vs 2.67 ± 0.54; P = 0.014), final TIMI frame count (11.71 ± 4.58 vs 18.04 ± 17.32; P = 0.012) and a nonsignificant improvement in the final myocardial blush grade value (2.58 ± 0.58 vs 2.43 ± 0.76; P = 0.255).
  
  
  CONCLUSIONS
  Data obtained from this ancillary study of the COCTAIL II suggest that the presence of high residual intrastent thrombus in patients undergoing primary angioplasty is associated with worsened final microcirculatory indexes.
authors.affiliation: aSan Giovanni Addolorata Hospital bCentro per la Lotta Contro L'Infarto - CLI Foundation, Rome cOspedale Civile Ferdinando Veneziale, Isernia dMisericordia Hospital, Grosseto, Italy eCentral Clinical Hospital of the Ministry of Interior, Warsaw, Poland fInstitute of Cardiology, UCSC, Rome gGVM Care and Research, E. S. Health Science Foundation, Cotignola, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Gatto
authors.forename: Enrico
authors.initials: E
authors.lastname: Romagnoli
authors.forename: Francesco
authors.initials: F
authors.lastname: Versaci
authors.forename: Ugo
authors.initials: U
authors.lastname: Limbruno
authors.forename: Tomasz
authors.initials: T
authors.lastname: Pawlowski
authors.forename: Italo
authors.initials: I
authors.lastname: Porto
authors.forename: Valeria
authors.initials: V
authors.lastname: Marco
authors.forename: Luca
authors.initials: L
authors.lastname: Di Vito
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Imola
authors.forename: Alberto
authors.initials: A
authors.lastname: Cremonesi
authors.forename: Francesco
authors.initials: F
authors.lastname: Prati
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003326:Coronary Circulation; D003328:Coronary Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D011237:Predictive Value of Tests; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D015607:Stents; D017131:Thrombectomy / Q000009:adverse effects; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome