Laser Vaporization of Intracoronary Thrombus and Identifying Plaque Morphology in ST-Segment Elevation Myocardial Infarction as Assessed by Optical Coherence Tomography

Relationship between thrombolysis in myocardial infarction blood flow before percutaneous coronary intervention and the morphological characteristics of culprit vessel plaques in patients with STEMI

The present study aimed to investigate the relationship between morphological characteristics of culprit coronary plaques and thrombolysis in myocardial infarction (TIMI) blood flow grade in patients with ST-segment elevation myocardial infarction (STEMI). According to the TIMI blood flow of the culprit vessel before percutaneous coronary intervention (PCI), 222 patients with STEMI were divided into two groups: TIMI 0/1 group (n=164) and TIMI 2/3 group (n=58). The baseline characteristics, coronary angiographic findings and optical coherence tomography images were collected. Multivariate logistic regression analysis was used to identify factors independently associated with poor initial TIMI blood flow. Compared with TIMI 2/3 group, TIMI 0/1 group had a significantly smaller minimum lumen diameter, greater diameter stenosis and longer lesion length, a higher incidence of lipid plaque, larger lipid length, maximum lipid arc, lipid index and maximum cross-sectional area (CSA) of plaque rupture, as well as a higher prevalence of thin-cap fibroatheroma (TCFA) and healed plaque (P<0.05). Multivariate logistic analysis demonstrated that lipid plaque, lipid length, maximum lipid arc, lipid index, TCFA, maximum CSA of plaque rupture and healed plaque were significantly associated with poor initial TIMI blood flow (P<0.05). In conclusion, the present study revealed that the morphological characteristics of culprit coronary plaques (lipid plaque, lipid length, maximum lipid arc, lipid index, TCFA, maximum CSA of plaque rupture and healed plaque) are significantly associated with poor initial TIMI blood flow before PCI in patients with STEMI.

Restenosis after excimer laser coronary atherectomy and drug-coated balloon dilation in Takayasu's arteritis: a case report and review of the literature

Takayasu's arteritis (TAK) is a rare chronic granulomatous arteritis that mainly affects the aorta and its major branches. Coronary artery (CA) involvement can be observed in 10-25% of TAK patients. We report a 21-year-old young female who was previously diagnosed with TAK and severe left main coronary artery (LMCA) stenosis and underwent numerous percutaneous coronary interventions (PCIs) in our hospital due to in-stent restenosis (ISR). This time, an excimer laser coronary atherectomy (ELCA) and drug-coated balloon (DCB) dilation was taken at the LMCA for the ISR. The blood flow was smooth after the operation, and she was symptom-free after discharge. Unfortunately, 5 months later, severe intimal hyperplasia was still seen in the stent of LMCA and left anterior descending (LAD) coronary artery. A coronary artery bypass graft surgery (CABG) was performed, and she has been symptom-free ever since. ELCA plus DCB is one of the novel ways we first reported. However, ensuring long-term inflammation control is equally important to restore blood flow. The combination of revascularization and anti-inflammation/immunosuppression is recommended to improve the outcomes of TAK patients with CA involvements.