Abstract 17839: Attenuated Plaque: Novel IVUS Predictors of No-reflow in the Percutaneous Coronary Intervention of Thrombus-Containing Lesions
We investigated the relationship between no-reflow and pre-intervention intravascular ultrasound (IVUS) findings in 87 patients with angiographic evidence of target lesion thrombus (defined as presence of generalized haziness or filling defect) within native arteries undergoing percutaneous coronary intervention (PCI) without a distal protection device. Angiographic no-reflow was defined as post-PCI TIMI flow grade 0∼2. IVUS assessment included (1) morphological characteristics of thrombus (scintillating appearance, lobulated mass, distinct interface between the suspect thrombi and plaque, or microchannels within a lobulated mass), (2) thrombus mobility, and (3) presence of attenuated plaque (plaque with deep echo attenuation, but without calcification).
Results: There were no serious IVUS-imaging related procedural complications. IVUS identified thrombus in 59 lesions (67.8%): scintillation in 39.1%, lobulated mass in 56.3%, distinct interface in 10.3%, microchannels in 9.2%, mobility in 24.1%, and attenuated plaque in 41.4%. Most attenuated plaques (88.9%) were detected at the minimal lumen area site. No-reflow was observed in 21 lesions post-PCI (24.1%). In general, IVUS features of thrombus were significantly more common in lesions that developed no-reflow; however, multivariate logistic regression analysis showed that attenuated plaque (p=0.012; OR, 6.04; 95% CI, 2.33∼15.70) and thrombus mobility (p<0.0001; OR, 31.33; 95% CI, 6.54∼149.93) were independent predictors of post-PCI no-reflow in angiographic thrombus-containing lesion.
Conclusions: IVUS imaging of angiographic thrombus-containing target lesions is safe. In thrombus-containing native coronary artery lesions IVUS findings of mobility and attenuated plaque predict no-reflow; and the use of distal protection should be considered.
- © 2011 by American Heart Association, Inc.