Coronary artery thrombus

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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; 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.
  • 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. 1.0 1.1 "http://www.cts.usc.edu/zglossary-thrombosis.html". Retrieved 14 November 2013. External link in |title= (help)
  2. 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)
  3. 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. 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)