Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions

Souteyrand, G., Amabile, N., Combaret, N., Hammas, S., Prati, F., Berry, C. , Pereira, B., Lusson, J.-R., Caussin, C. and Motreff, P. (2015) Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions. EuroIntervention, 11(8), pp. 895-904. (doi:10.4244/eijy14m07_18) (PMID:25033106)

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Abstract

Aims: To assess whether a strategy of invasive management without stents in selected acute coronary syndrome (ACS) patients with a large thrombus burden (LTB) might be feasible and safe. Methods and results: We performed a prospective non-randomised observational cohort study of invasive treatment decisions guided by optical coherence tomography (OCT) in selected ACS patients with LTB. Among 852 ACS patients who had undergone invasive coronary angiography, 101 (11.8%) patients with large thrombus burden on initial angiography underwent thrombectomy to restore TIMI 3 flow without stenting. All of these patients then had repeat angiography with OCT (days 0-2 [Group 1], days 3-6 [Group 2] or days 7-30 [Group 3]). No adverse events occurred between the initial and second angiograms. Residual thrombus was detected in 68% of patients with OCT (respectively, 94%, 79% and 32% in Group 1, Group 2 and Group 3), and 20% of cases with angiography. Plaque rupture was detected by OCT in 65% of cases. Minimal lumen area was 2.81 mm2, 3.40 mm2 and 4.89 mm2 in Group 1, Group 2 and Group 3, respectively. Sixty-two percent of patients were stented (respectively, 76%, 61% and 50%). During a minimum follow-up period of 12 months in all patients, one non-fatal MI occurred and one PCI was performed for angina. Conclusions: Medical management without stents is safe and feasible in selected ACS patients with LTB. OCT revealed culprit lesion characteristics that were not disclosed by angiography and facilitated treatment decisions.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin
Authors: Souteyrand, G., Amabile, N., Combaret, N., Hammas, S., Prati, F., Berry, C., Pereira, B., Lusson, J.-R., Caussin, C., and Motreff, P.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:EuroIntervention
Publisher:Europa Digital & Publishing
ISSN:1774-024X
ISSN (Online):1969-6213
Copyright Holders:Copyright © 2015 Europa Digital and Publishing
First Published:First published in EuroIntervention 11(8):895-904
Publisher Policy:Reproduced with permission of editor

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