Myocardial infarction with non-obstructive thrombus validated by optical coherence tomography

Abstract

Purpose. Coronary angiography provides no details on underlying pathology in acute coronary syndromes (ACS). Optical coherence tomography (OCT) can visualize coronary atherosclerosis, thrombus formation, and plaque rupture in patients with myocardial infarction (MI) where coronary angiography is unclear. Materials and methods. We present a case series containing six young patients with ACS, four of them due to non-obstructive thrombus, in whom the operators refrained from stent implantation despite an identifiable culprit lesion with OCT-validated thrombus formation. Results. The median age was 31.5 years. In four of these six patients, no invasive intervention was performed while the remaining two patients underwent thrombus aspiration and balloon angioplasty without stent implantation. Four patients were examined at the primary evaluation and all patients were examined by OCT between 3–5 days after initial examination. This short-term follow-up with OCT showed non-obstructive thrombus formation in all patients with varying degrees of thrombus resolution. No adverse cardiac events were reported after a median follow up of 5.5 months. Conclusions. OCT can visualize thrombus formation in young ACS patients with non-obstructive thrombus or following thrombus reduction by aspiration and balloon dilatation. These patients seems safely treated with a conservative medical approach rather than with stent implantation.