Glistening Thrombi Gushed from the Culprit Lesion One Month after Myocardial Infarction
Takahiro Hayashi, Takashi Kiyoshima, Kinji Ishikawa
Department of Cardiology, Kinki University School of Medicine, Osaka, Japan
A 58-year-old man presented at our hospital with precordial pain. An electrocardiogram showed an acute inferior myocardial infarction, and coronary angiography revealed a thrombotic occlusion of the proximal portion of right coronary artery, which was then treated successfully with stent implantation. Thereafter, the patient took aspirin (81 mg) and ticlopidine (200 mg) daily. On day 30 after onset, the right coronary artery was again examined angiographically and angioscopically. No restenosis or filling defects were observed within the culprit lesion in the right coronary artery (Figure A, white arrow). At the site of the culprit lesion, we observed residual white (WT) and mixed thrombi (MT) into which the stent struts (SS) were partially immersed (Figure B, No. 1). During this examination, a dark red substance with glistening yellow particles resembling toothpaste suddenly gushed from underneath the thrombi in the disrupted plaque lesion (Figure B, from No. 2 to No. 8). This suggests that significant thrombogenic content, including inflammatory cells and tissue factors, can still be present within the culprit lesion one month after myocardial infarction. A likely consequence of this strong thrombogenicity is the continued presence of thrombi and a delayed healing process. It was also notable that glistening thrombi gushed from the coronary stenting site within the disrupted culprit lesion. The small glistening fragments are thought to have been the content of the plaque. This angioscopic image thus appears to capture the moment at which thrombi mixed with plaque were squeezed out of the lesion during the organizing process.
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