Latest Concepts in Diagnosis and Management of Coronary Thrombus

Abstract

Coronary thrombus is an integral part of unstable atherosclerotic plaque causing acute coronary syndrome. The thrombus results from a either a disrupted atherosclerotic plaque or plaque erosion. A vulnerable plaque initiates the formation of a thrombus which consists of platelets, red blood cells, vasoconstrictors, and procoagulant bound by fibrin fibers. intracoronary thrombi (ICT) can be red or white. Angiography is the gold standard for diagnosis of coronary thrombus. Thrombus burden inversely impacts myocardial perfusion, with high thrombus burden resulting in sub optimal primary percutaneous coronary intervention (PCI) results and poor outcome. Management of ICT is a therapeutic challenge and involves a combination of pharmacological and mechanical therapies. Low thrombus burden is dealt with standard pharmacotherapy, balloon angioplasty, and stenting with occasional need to use aspiration catheter. High thrombus burden requires a targeted thrombus strategy.