Coronary artery thrombus

Coronary Angiography
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General Principles Overview Historical Perspective Contraindications Appropriate Use Criteria for Revascularization Complications Technique Film Quality
Anatomy & Projection Angles
Normal Anatomy Coronary arteries Dominance Right System Left System Left Main Left Anterior Descending Circumflex Median Ramus
Anatomic Variants Separate Ostia Anomalous Origins Case Example Fistula
Projection Angles Standard Views Left Coronary Artery Right Coronary Artery
Epicardial Flow & Myocardial Perfusion
Epicardial Flow TIMI Frame Count TIMI Flow Grade TIMI Grade 0 Flow TIMI Grade 1 Flow TIMI Grade 2 Flow TIMI Grade 3 Flow TIMI Grade 4 Flow Pulsatile Flow Deceleration
Myocardial Perfusion TIMI Myocardial Perfusion Grade TMP Grade 0 TMP Grade 0.5 TMP Grade 1 TMP Grade 2 TMP Grade 3
Lesion Complexity
ACC/AHA Lesion-Specific Classification of the Primary Target Stenosis
Preprocedural Lesion Morphology Eccentricity Irregularity Ulceration Intimal Flap Aneurysm Sawtooth Pattern Length Ostial location Angulation Proximal tortuosity Degenerated SVG Calcification Total occlusion Coronary Artery Thrombus TIMI Thrombus Grade TIMI Thrombus Grade 0 TIMI Thrombus Grade 1 TIMI Thrombus Grade 2 TIMI Thrombus Grade 3 TIMI Thrombus Grade 4 TIMI Thrombus Grade 5 TIMI Thrombus Grade 6
Lesion Morphology Quantitative Coronary Angiography Definitions of Preprocedural Lesion Morphology Irregular Lesion Disease Extent Arterial Foreshortening Infarct Related Artery Restenosis Degenerated SVG Collaterals Aneurysm Bifurcation Trifurcation Ulceration
Left ventriculography
Technique Quantification of LV Function Quantification of Mitral Regurgitation

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

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.

Definition

The coronary artery thrombus may be defined as an occlusion or blockage of blood flow within a vessel due to a clot.

Pathophysiology

Arterial thrombosis is typically associated with athero- sclerotic plaque rupture. This pathogenic process results in exposure or release of subendothelial cells and procoagu- lant material (e.g., TF, collagen) from within the plaque and activation and aggregation of platelets. The growing thrombus increases the degree of stenosis, which can result in extremely high shear rates (up to 70,000 s􏰂 1 ) within the stenotic region.53 In some cases, depending on stenosis geometry and location in the vasculature, turbulent flow may develop downstream of the stenosis. Ultimately, plate- let accumulation and fibrin deposition produces an occlu- sive platelet-rich intravascular thrombus.

Interplay between abnormali- ties in blood components, the vascula- ture, and blood flow contribute to the development of arterial thrombosis. Arte- rial thrombosis involves the formation of platelet-rich “white clots” that form after rupture of atherosclerotic plaques and exposure of procoagulant material such as lipid-rich macrophages (foam cells), collagen, tissue factor, and/or endothe- lial breach, in a high shear environment.

Clinical Significance

• The location of the thrombosis is clinically relevant once the infarction may be subclinical or not.
• Coronary thrombosis may be a complication related to drug-eluting stents.