Coronary artery thrombus: Difference between revisions
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* Coronary thrombosis may be a complication related to drug-eluting [[stents]].<ref name="Lüscher-2007">{{Cite journal | last1 = Lüscher | first1 = TF. | last2 = Steffel | first2 = J. | last3 = Eberli | first3 = FR. | last4 = Joner | first4 = M. | last5 = Nakazawa | first5 = G. | last6 = Tanner | first6 = FC. | last7 = Virmani | first7 = R. | title = Drug-eluting stent and coronary thrombosis: biological mechanisms and clinical implications. | journal = Circulation | volume = 115 | issue = 8 | pages = 1051-8 | month = Feb | year = 2007 | doi = 10.1161/CIRCULATIONAHA.106.675934 | PMID = 17325255 }}</ref> | * Coronary thrombosis may be a complication related to drug-eluting [[stents]].<ref name="Lüscher-2007">{{Cite journal | last1 = Lüscher | first1 = TF. | last2 = Steffel | first2 = J. | last3 = Eberli | first3 = FR. | last4 = Joner | first4 = M. | last5 = Nakazawa | first5 = G. | last6 = Tanner | first6 = FC. | last7 = Virmani | first7 = R. | title = Drug-eluting stent and coronary thrombosis: biological mechanisms and clinical implications. | journal = Circulation | volume = 115 | issue = 8 | pages = 1051-8 | month = Feb | year = 2007 | doi = 10.1161/CIRCULATIONAHA.106.675934 | PMID = 17325255 }}</ref> | ||
==[[TIMI thrombus grade|TIMI Thrombus | ==[[TIMI thrombus grade|TIMI Thrombus Grade]]== | ||
A patient is considered to have angiographically evident thrombus (AET) if TIMI thrombus grades 2 to 5 are present.<ref name="Gibson-2001">{{Cite journal | last1 = Gibson | first1 = CM. | last2 = de Lemos | first2 = JA. | last3 = Murphy | first3 = SA. | last4 = Marble | first4 = SJ. | last5 = McCabe | first5 = CH. | last6 = Cannon | first6 = CP. | last7 = Antman | first7 = EM. | last8 = Braunwald | first8 = E. | title = Combination therapy with abciximab reduces angiographically evident thrombus in acute myocardial infarction: a TIMI 14 substudy. | journal = Circulation | volume = 103 | issue = 21 | pages = 2550-4 | month = May | year = 2001 | doi = | PMID = 11382722 }}</ref> | A patient is considered to have angiographically evident thrombus (AET) if TIMI thrombus grades 2 to 5 are present.<ref name="Gibson-2001">{{Cite journal | last1 = Gibson | first1 = CM. | last2 = de Lemos | first2 = JA. | last3 = Murphy | first3 = SA. | last4 = Marble | first4 = SJ. | last5 = McCabe | first5 = CH. | last6 = Cannon | first6 = CP. | last7 = Antman | first7 = EM. | last8 = Braunwald | first8 = E. | title = Combination therapy with abciximab reduces angiographically evident thrombus in acute myocardial infarction: a TIMI 14 substudy. | journal = Circulation | volume = 103 | issue = 21 | pages = 2550-4 | month = May | year = 2001 | doi = | PMID = 11382722 }}</ref> | ||
Revision as of 16:56, 15 November 2013
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Coronary Angiography | |
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General Principles | |
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Anatomy & Projection Angles | |
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Normal Anatomy | |
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Anatomic Variants | |
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Projection Angles | |
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Epicardial Flow & Myocardial Perfusion | |
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Epicardial Flow | |
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Myocardial Perfusion | |
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Lesion Complexity | |
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ACC/AHA Lesion-Specific Classification of the Primary Target Stenosis | |
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Lesion Morphology | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Vanessa Cherniauskas, M.D. [2]
Synonyms and keywords: Coronary thrombosis; coronary thrombus
Overview
The Thrombus of coronary arteries occurs when the lumen, of the artery starts becoming smaller and creates a narrowed segment in which the blood flow clots slowly in the artery. This phenomenum in coronary artery decreases the perfusion and may cause necrosis which may lead to a heart attack if not treated.[1]
Definition
The coronary artery thrombus may be defined as an occlusion or blockage of blood flow within a vessel due to a clot.[1]
Pathophysiology
The pathogenic process of arterial thrombosis involves the formation of platelet-rich “white clots” after the rupture of atherosclerotic plaques and exposure of procoagulant material such as lipid-rich macrophages (foam cells), collagen, tissue factor, and/or endothelial breach, in a high shear environment. The exposed material come from within the plaque and also from the activation and aggregation of platelets. Platelet accumulation and fibrin deposition cause an occlusive platelet-rich intravascular thrombus. The growing thrombus increases the degree of narrowing, which may result in extremely high shear rates within the stenotic region. This phenomenum is responsible for a turbulent flow which is developed downstream of the stenosis depending on stenosis geometry and location in the vasculature.[2][3]
Clinical Significance
- The location of the thrombosis is clinically relevant once the infarction may be subclinical or not.[4]
- Coronary thrombosis may be a complication related to drug-eluting stents.[4]
TIMI Thrombus Grade
A patient is considered to have angiographically evident thrombus (AET) if TIMI thrombus grades 2 to 5 are present.[5]
TIMI Thrombus Grade 0
- None (no cineangiographic characteristics of thrombus present).
TIMI Thrombus Grade 1
- Possible thrombus present.
- Angiography demonstrates characteristics such as reduced contrast density, haziness, irregular lesion contour or a smooth convex "meniscus" at the site of total occlusion suggestive but not diagnostic of thrombus.
TIMI Thrombus Grade 2
- Thrombus present (small size).
- Definite thrombus with greatest dimensions less than or equal to ½ vessel diameter.
TIMI Thrombus Grade 3
- Thrombus present (moderate size).
- Definite thrombus but with greatest linear dimension greater than ½ but less than 2 vessel diameters.
TIMI Thrombus Grade 4
- Thrombus present (large size).
- As in Grade 3 but with the largest dimension greater than or equal to 2 vessel diameters.
TIMI Thrombus Grade 5
- Recent total occlusion, can involve some collateralization but usually does not involve extensive collateralization.
- The clot has not propagated backward to the most distal branch and there is often a beak-like appearance of the occlusion.
TIMI Thrombus Grade 6
- Chronic total occlusion, usually involving extensive collateralization.
- Tends to have distinct, blunt cut-off/edge and will generally clot up to the nearest proximal side branch.
Treatment
Examples
References
- ↑ 1.0 1.1 "http://www.cts.usc.edu/zglossary-thrombosis.html". Retrieved 14 November 2013. External link in
|title=(help) - ↑ Bark, DL.; Ku, DN. (2010). "Wall shear over high degree stenoses pertinent to atherothrombosis". J Biomech. 43 (15): 2970–7. doi:10.1016/j.jbiomech.2010.07.011. PMID 20728892. Unknown parameter
|month=ignored (help) - ↑ Wolberg, AS.; Aleman, MM.; Leiderman, K.; Machlus, KR. (2012). "Procoagulant activity in hemostasis and thrombosis: Virchow's triad revisited". Anesth Analg. 114 (2): 275–85. doi:10.1213/ANE.0b013e31823a088c. PMID 22104070. Unknown parameter
|month=ignored (help) - ↑ 4.0 4.1 Lüscher, TF.; Steffel, J.; Eberli, FR.; Joner, M.; Nakazawa, G.; Tanner, FC.; Virmani, R. (2007). "Drug-eluting stent and coronary thrombosis: biological mechanisms and clinical implications". Circulation. 115 (8): 1051–8. doi:10.1161/CIRCULATIONAHA.106.675934. PMID 17325255. Unknown parameter
|month=ignored (help) - ↑ Gibson, CM.; de Lemos, JA.; Murphy, SA.; Marble, SJ.; McCabe, CH.; Cannon, CP.; Antman, EM.; Braunwald, E. (2001). "Combination therapy with abciximab reduces angiographically evident thrombus in acute myocardial infarction: a TIMI 14 substudy". Circulation. 103 (21): 2550–4. PMID 11382722. Unknown parameter
|month=ignored (help)