Costa, M (Marco)

Feijter, Pim

Kross, JM

Ligthart, JMR

Sabaté Tenas, M

Serrano, P

English

EUR Research Repository

Diagnosis of an Intracoronary Thrombus WithIntravascular UltrasoundP. Serrano, MD; J.M. Kross, MD; J.M.R. Ligthart, Tech; M.A. Costa, MD;M. Sabate´, MD; P.J. de Feyter, MD, PhDA60-year-old man was referred for coronary angiographybecause of exertional angina (Canadian CardiovascularSociety angina classification type II). Twelve years earlier, hehad had a myocardial infarction with a venous bypass graft tothe right coronary artery. Two months before we saw him, astent (Figure 1A) was placed in the distal part of the venousgraft because of stable angina.Angiography showed an eccentric negative image of asevere stenosis at the proximal part of the saphenous veingraft (Figure 1B). Intravascular ultrasound imaging(0.5 mm/s motorized pullback with a 30-MHz UltraCrossechocatheter, SciMed, Boston Scientific Corp) showed anecholucent, homogeneous, well-delineated, diaphragm-likeimage almost occluding the vessel lumen (Figure 1D and 1E).Direct atherectomy was performed with good angiographic(Figure 1C) and intravascular ultrasound (Figure 1F) results.Two biopsies from the atherectomy were processed forroutine paraffin embedding. Conventional hematoxylin-eo-sin–stained images (Figure 2A and 2B) demonstrated astraight interface (arrow) between the “normal” vessel walltissue and the tissue causing the stenosis. This consisted ofyoung fibroblasts in a mixoid extracellular matrix, suggestingchronic thrombus. To confirm our findings, we stained withanti-CD31 and anti-CD34 antibodies (Figure 2D and 2E),which demonstrated endothelial cells forming new capillaries(arrows) within the thrombus. In a section stained with vanGieson’s elastica stain, resolution of the elastica interna at thesite of the thrombosis was shown (Figure 2C).From the Thoraxcenter, Dijkzigt University Hospital, Rotterdam, Netherlands.Correspondence to P. Serrano, MD, Interventional Cardiology Department, Servicio de Cardiologı´a, C ı́nico Universitario Lozano Blesa, Avenida SanJuan Bosco No. 15, 50.009 Zaragoza, Spain. E-mail pserranoa@meditex.esThe editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital andTexas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute,6720 Bertner Ave, MC1-267, Houston, TX 77030.(Circulation. 2000;101:e84-e85.)© 2000 American Heart Association, Inc.Circulation is available at http://www.circulationaha.org1Images in Cardiovascular Medicine2 Circulation February 29, 2000

Diagnosis of an intracoronary thrombus with intravascular ultrasound

https://pure.eur.nl/files/46611832/10694536.pdf

Diagnosis of an intracoronary thrombus with intravascular ultrasound

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