Abstract 2850: Thrombus Constitutes 75% of Culprit Lesion Endoluminal Obstruction in Acute Coronary Syndrome
The exact contribution of thrombus to the obstruction caused by atherothrombotic culprit lesions (CL) in acute coronary syndrome (ACS) remains to be determined. The present study therefore sought to quantify this parameter precisely.
Methods and Results: Thirty-two ACS patients with troponin elevation (mean age = 57+/−12 y; 91% male; 78% STEMI; 47% TIMI flow 0/1) were included. Distal protection filter was set up for each CL, and then the thrombus was triggered by repeated low-pressure balloon inflation (shaking). The idea was to obtain pure thrombus reduction (TR) without longitudinal plaque redistribution (LPR) or vessel overstretch (VO). Quantitative IVUS analysis was performed prior to and following this balloon shaking. Vessel area and lumen area were measured. At baseline, the CL stenosis area was 85% with a 1.08 positive remodeling index. After shaking, VO was negligible (2.3%); LPR was absent on the 3D IVUS reconstruction; and stenosis area was 21%. TR was confirmed histologically on debris collected in the distal filter. Final TIMI flow-rate was never less than 2 (94% TIMI 3).
Conclusion: In ACS, thrombus constitutes 75% of the endoluminal obstruction. Consequently, the stenosis directly due to the vulnerable atheromatous plaque prior to its destabilization was non-significant.