Thrombotic lesion
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
A thrombus is a blood clot in an intact blood vessel. The presence of angiographically evident thrombus (AET) is associated with embolization and impaired myocardial perfusion.[1][2]
Thrombus Grading
In order to more objectively and quantitatively characterize thrombus on a coronary angiogram, the PERFUSE study group developed the following thrombus grading system:[3]
- PERFUSE Grade 0
- PERFUSE Grade 1
- PERFUSE Grade 2
- PERFUSE Grade 3
- PERFUSE Grade 4
- PERFUSE Grade 5
- PERFUSE Grade 6
Click here for details about thrombus grading.
Management of the Thrombotic Lesion
The presence of angiographically apparent thrombus is associated with poorer outcomes in patients undergoing PCI. Thrombus often embolizes distally and causes no reflow and associated myonecrosis. There are two broad strategies to reduce thrombus burden: mechanical strategies and pharmacologic strategies.
Click here for details about the management of thrombotic lesions.
References
- ↑ Kirtane AJ, Vafai JJ, Murphy SA, Aroesty JM, Sabatine MS, Cannon CP; et al. (2006). "Angiographically evident thrombus following fibrinolytic therapy is associated with impaired myocardial perfusion in STEMI: a CLARITY-TIMI 28 substudy". Eur Heart J. 27 (17): 2040–5. doi:10.1093/eurheartj/ehl149. PMID 16847010.
- ↑ Kirtane AJ, Weisbord A, Karmpaliotis D, Murphy SA, Giugliano RP, Cannon CP; et al. (2005). "Relation of impaired Thrombolysis In Myocardial Infarction myocardial perfusion grades to residual thrombus following the restoration of epicardial patency in ST-elevation myocardial infarction". Am J Cardiol. 95 (2): 224–7. doi:10.1016/j.amjcard.2004.09.007. PMID 15642554.
- ↑ Gibson CM, de Lemos JA, Murphy SA, Marble SJ, McCabe CH, Cannon CP; et al. (2001). "Combination therapy with abciximab reduces angiographically evident thrombus in acute myocardial infarction: a TIMI 14 substudy". Circulation. 103 (21): 2550–4. PMID 11382722.