Radiofrequency-Intravascular Ultrasound Assessment of Lesion Coverage After Angiography-Guided Emergent Percutaneous Coronary Intervention in Patients With Non-ST Elevation Myocardial Infarction

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• 作者：Jacek Legutko ; Jacek Jakala ; Gary S. Mintz ; Grzegorz L. Kaluza ; Blaz Mrevlje ; Lukasz Partyka ; Marcin Wizimirski ; Lukasz Rzeszutko ; Angela Richter ; Pauliina Margolis ; Dariusz Dudek
• 刊名：The American Journal of Cardiology
• 出版年：15 December, 2013
• 年：2013
• 卷：112
• 期：12
• 页码：1854-1859
• 全文大小：899 K

文摘

Using radiofrequency-intravascular ultrasound (VH-IVUS), we have previously demonstrated that in 50% of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention with optimal angiographic result, the stent does not fully cover the whole VH-IVUS-derived thin-cap fibroatheroma (VH-TCFA) related to the culprit lesion. Presently, we set out to extend these findings to 20 patients with non-STEMI with Thrombolysis In Myocardial Infarction flow 3 in the infarct-related artery before intervention who were then treated with angiography-guided direct stent implantation. The lesion was imaged with VH-IVUS before and after intervention, but the results were blinded to the operator. Plaque rupture site was identified in 8 lesions (40%), all proximal to the minimum lumen area (MLA) site. The maximum necrotic core site was found proximal to MLA in 18 lesions and at the MLA in 2 lesions. Although the plaque rupture site was fully covered with the stent in all lesions, an uncovered VH-TCFA was found in 7 lesions (35%), 4 in the proximal reference segment, 1 in the distal reference segment, and 2 in both the proximal and distal reference segments. In conclusion, in 35% of patients with non-STEMI undergoing angiography-guided emergent percutaneous coronary intervention, the stent does not fully cover a VH-TCFA related to the culprit lesion.