Abstract 13715: Correlation between Thin Cap Fibroatheroma and No-Reflow Phenomenon Induced by Stent Deployment in Acute Coronary Syndrome - Histological Evaluation -
Background: It has been reported that post-stenting no-reflow is associated with thin cap fibroatheroma defined by virtual histology-intravascular ultrasound (VH-TCFA) in patients with acute coronary syndrome (ACS), however it is unclear why stent deployment of VH-TCFA area can induce no-reflow phenomenon. To clarify the above-mentioned mechanism, we examined the correlation between stenting in VH-TCFA area and histology of retrieved material using filter and thrombectomy in ACS.
Methods: Eighty-nine consecutive ACS patients who received VH-IVUS-guided coronary intervention with distal protection filter device and thrombectomy were enrolled. We divided our patients into VH-TCFA group in whom VH-TCFA was found before stent deployment and non VH-TCFA group in whom VH-TCFA was not found. We compared the incidence of filter no-reflow (FNR) and histology of retrieved material between the two groups.
Results: The incidence of FNR and atheromatous substances in the retrieved material was significantly higher in VH-TCFA group than non VH-TCFA group (table). On the retrieved material, atheromatous substances tended to induce FNR more frequently than only fibrinous clot or thrombus. After removing the filter, no patients show slow or no-reflow phenomenon.
Conclusions: Stent deployment of VH-TCFA area may frequently produce atheromatous substances which can induce no-reflow phenomenon. The filter protection device should be used if VH-TCFA is found before stenting.
- © 2012 by American Heart Association, Inc.