Intracoronary Thrombus, Myocardial Infarction
Conditions
Keywords
optimal coherence tomography, myocardial reperfusion
Brief summary
The pharmacoinvasive approach after thrombolysis is the standard treatment of myocardial infarction when deadlines are too long for primary angioplasty. Coronary angioplasty is then carried out within 3 to 24 hours following thrombolysis. The adjuvant antiplatelet therapy of thrombolysis combines aspirin with clopidogrel (75 or 300 mg depending on age). These clopidogrel doses are associated with a very low anti-platelet aggregation response within 24 hours following administration. However, the antiplatelet agregation that inhibits the progression of intracoronary thrombus must be optimal at the time of angioplasty to reduce the risk of thrombotic events. Intracoronary thrombus residual angiographic post-thrombolysis was associated with impaired myocardial reperfusion but coronary angiography has a very low sensitivity for detecting the thrombus. The optical coherence tomography (OCT) is currently the method of choice to visualize and quantify the intracoronary thrombus. It is used routinely in the presence of a thrombus to correctly estimate the size of the artery and for the evaluation of good stent apposition. The thrombectomy at the time of angioplasty improves myocardial reperfusion, particularly in case of major thrombotic mass. Intracoronary thrombus residual post-thrombolysis could be a marker for the quality of reperfusion itself correlated to the quality of the antiplatelet post-thrombolysis. The investigators therefore hypothesize that the systematic use of the OCT before elective angioplasty (within 3 to 24 hours) after successful thrombolysis could be used to guide the use of thrombectomy and adequate stenting and thus improve myocardial reperfusion. Our study will also correlate the importance of the residual thrombus before angioplasty myocardial reperfusion one hand and to the inhibition of platelet activity observed other.
Interventions
DEVICEoptimal coherence tomography
Sponsors
University Hospital, Caen
Study design
Observational model
COHORT
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* acute myocardial infarction * treated with successful fibrinolysis * who require coronary stenting
Exclusion criteria
* cardiogenic shock * hemostasis disorders * non accessible coronary lesion for OCT * severe renal insuffisiency
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| myocardial reperfusion of systematic guidance measured by OCT of the angioplasty procedure | baseline | in patients treated with thrombolysis and requiring the establishment of a stent |
Secondary
| Measure | Time frame |
|---|---|
| volume of thrombus messured by OCT before angioplasty | 24hours |
| inhibition of platelet activity evaluated by aggregometry | 24hours |
Countries
France
Outcome results
None listed