Coronary artery thrombus
Coronary Angiography | |
General Principles | |
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Anatomy & Projection Angles | |
Normal Anatomy | |
Anatomic Variants | |
Projection Angles | |
Epicardial Flow & Myocardial Perfusion | |
Epicardial Flow | |
Myocardial Perfusion | |
Lesion Complexity | |
ACC/AHA Lesion-Specific Classification of the Primary Target Stenosis | |
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
TIMI Thrombus Grade 0
- No cineangiographic characteristics of thrombus present.
TIMI Thrombus Grade 1
- Hazy, 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
- Tends to have a distinct, blunt cut-off/edgeand will generally clot up to the nearest proximal side branch.
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
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(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
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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
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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
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ignored (help)