Aims: The aim of this study was to understand better the mechanisms of repair of plaque complications causing acute coronary syndrome. At follow-up OCT, the margins of the evacuated cavity in RFC plaques showed a smooth surface and a morphology similar to that of baseline images, while IFC plaques showed a smoothened intimal border and a double layering indicating organising thrombus incorporated in the superficial layers of the plaque.
The natural history of culprit plaques, both with a ruptured fibrous cap RFC and with an intact fibrous cap IFC , causing an acute coronary syndrome ACS has not been systematically investigated in vivo 1. In 10 patients with ACS, we used serial optical coherence tomography OCT to explore the repair and healing morphology of non-critically narrowed culprit plaques, both with RFC and IFC, which were treated with thrombus aspiration or systemic thrombolysis alone without angioplasty or stent implantation.
This is a hypothesis-generating prospective study which was performed using 10 patients with ACS Table 1. Twenty-five patients with ACS were scrutinised over four months. Seven patients received thrombus aspiration, two were treated with IV abciximab and one with systemic thrombolysis Table 2. Baseline OCT study of culprit lesions was obtained after 5. Patient characteristics and procedural details are described in Table 1 and Table 2.
All procedures were performed according to the current guidelines. Patients received aspirin, thienopyridine, and unfractionated heparin 5,, IU Table 2. After discharge, patients underwent coronary angiogram and OCT assessments as per local practice. The repeat angiogram with OCT was done at two, four, six and seven months in four, one, four and one patient, respectively. Written informed consent was obtained before follow-up angiographic OCT procedures that were deemed clinically useful. Coronary angiograms were analysed off-line using quantitative coronary angiography QCA 3.
The OCT culprit lesion morphology was described according to previously reported criteria 2,4,5. Statistical significance was set at the two-tailed 0. Of the eight patients with STEMI, thrombus aspiration was performed in six, systemic thrombolysis in one, and the remaining patient was treated only with IV abciximab. The mean total ischaemic time was 2. Angiography confirmed the presence of a TIMI 3 flow in all cases without significant luminal compromise.
