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(Circulation. 2008;118:426-427.)
© 2008 American Heart Association, Inc.

Images in Cardiovascular Medicine

Fibrin Clot Visualized by Optical Coherence Tomography

Teruyoshi Kume, MD; Hiroyuki Okura, MD; Takahiro Kawamoto, MD; Takashi Akasaka, MD; Eiji Toyota, MD; Nozomi Watanabe, MD; Yoji Neishi, MD; Yoshito Sadahira, MD; Kiyoshi Yoshida, MD

From the Department of Cardiology (T. Kume, H.O., T. Kawamoto, E.T., N.W., Y.N., K.Y.) and Department of Pathology (Y.S.), Kawasaki Medical School, Kurashiki, Japan; and Department of Cardiology, Wakayama Medical University, Wakayama, Japan (T.A.).

Correspondence to Hiroyuki Okura, MD, Department of Cardiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701–0192, Japan. E-mail hokura{at}fides.dti.ne.jp

Optical coherence tomography (OCT) is a recently developed optical imaging technique that provides high-resolution (10 to 20 µm) cross-sectional images of vessels.¹ It has been reported that OCT images of white and red thrombus were characterized as backscattering protrusions in the coronary lumen.² However, OCT characteristics of fibrin clot composed of fibrin material and few blood cells have not been described.

The coronary arteries of a 75-year-old man who died from acute myocardial infarction were obtained at autopsy. Histopathological examination showed fibrin clot composed of fibrin material and few blood cells in the coronary artery (Figure, A and B). Before proceeding with a standard histopathological examination, we visualized the coronary artery using OCT. OCT characteristics of fibrin clot, a signal-rich structure without backscattering, were obviously different from white or red thrombus that were characterized as a signal-rich structure with backscattering (Figure, C).

View larger version (131K): [in this window] [in a new window]   Figure. Correlation between optical OCT images (C, F, and I) and histological examinations of human coronary fibrin clot (A and B), red thrombus (D and E), and white thrombus (G and H) obtained at autopsy. A and B, Fibrin clot was composed of fibrin material and few blood cells. *Fibrin clot, hematoxylin and eosin stain. D and E, Red thrombus (RT) consisted mainly of red blood cells (hematoxylin and eosin stain). H and I, White thrombus (WT) consisted mainly of platelets, fibrin, and white blood celld (hematoxylin and eosin stain). C, OCT image of fibrin clot was characterized as a signal-rich structure without backscattering. *Fibrin clot. F and I. OCT images of red and white thrombi were visualized as a signal-rich structure with backscattering (RT indicates red thrombus; WT; white thrombus).

Although drug-eluting stents have reduced rates of restenosis and late lumen loss compared with bare-metal stents, thrombosis has emerged as a major concern. In addition, delayed arterial healing, as evidenced by persistence of fibrin clot after DES implantation, has been demonstrated. Although OCT might be useful for monitoring structural changes after DES implantation, it might be difficult, using OCT, to discriminate fibrin clot from minimal neointimal formation after DES implantation.

	Disclosures

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None.

	References

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1. Kume T, Akasaka T, Kawamoto T, Watanabe N, Toyota E, Neishi N, Sukmawan R, Sadahira Y, Yoshida K. Assessment of coronary arterial plaque by optical coherence tomography. Am J Cardiol. 2006; 97: 1172–1175.[CrossRef][Medline] [Order article via Infotrieve]

2. Kume T, Akasaka T, Kawamoto T, Ogasawara Y, Watanabe N, Toyota E, Neishi N, Sukmawan R, Sadahira Y, Yoshida K. Assessment of coronary arterial thrombus by optical coherence tomography. Am J Cardiol. 2006; 97: 1713–1717.[CrossRef][Medline] [Order article via Infotrieve]

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kume, T. Articles by Yoshida, K. Search for Related Content PubMed Articles by Kume, T. Articles by Yoshida, K. Related Collections Arterial thrombosis Fibrinogen/fibrin Coronary imaging: angiography/ultrasound/Doppler/CC