Objectives. We evaluated the thrombus-vaporizing effect of excimer laser coronary angioplasty (ELCA) in patients with ST-segment elevation myocardial infarction (STEMI) by optical coherence tomography (OCT). Background. Larger intracoronary thrombus elevates the risk of interventional treatment and mortality in patients with STEMI. Methods. A total of 92 patients with STEMI who presented within 24 hours from the onset and underwent ELCA following manual aspiration thrombectomy (MT) were analyzed. Results. The mean baseline thrombolysis in myocardial infarction flow grade was 0.4 ± 0.6, which subsequently improved to 2.3 ± 0.7 after MT () and 2.7 ± 0.5 after ELCA (). The median residual thrombus volume after MT was 65.7 mm³, which significantly reduced to 47.5 mm³ after ELCA (). Plaque rupture was identified by OCT in only 22 cases (23.9%) after MT, but was distinguishable in 36 additional cases after ELCA (total: 58 cases; 63.0%). Ruptured lesions contained a higher proportion of red thrombus than nonruptured lesions (75.9% vs. 43.3%, ). Significantly larger thrombus burden after MT (69.6 mm³ vs. 56.3 mm³, ) and greater thrombus reduction by ELCA (21.2 mm³ vs. 11.8 mm³, ) were observed in ruptured lesions than nonruptured lesions. Conclusions. ELCA effectively vaporized intracoronary thrombus in patients with STEMI even after MT. Lesions with plaque rupture contained larger thrombus burden that was frequently characterized by red thrombus and more effectively reduced by ELCA.

中文翻译：

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光学相干断层扫描评估 ST 段抬高型心肌梗塞冠状动脉内血栓的激光汽化和斑块形态识别

目标。我们通过光学相干断层扫描 (OCT) 评估了准分子激光冠状动脉成形术 (ELCA) 在 ST 段抬高型心肌梗死 (STEMI) 患者中的血栓蒸发作用。背景。较大的冠状动脉内血栓会增加 STEMI 患者介入治疗和死亡的风险。方法。分析了总共 92 名 STEMI 患者，他们在发病后 24 小时内就诊，并在手动抽吸血栓切除术 (MT) 后接受了 ELCA。结果。心肌梗死血流分级的平均基线溶栓为 0.4 ± 0.6，随后在 MT 后改善至 2.3 ± 0.7（)和 2.7 ± 0.5 后 ELCA (）。MT 后的中位残余血栓量为 65.7 mm ³ ， ELCA 后显着降低至 47.5 mm ^{3 （}）。MT 后仅 22 例（23.9%）的 OCT 发现斑块破裂，但在 ELCA 后的另外 36 例中可区分（总计：58 例；63.0%）。与未破裂的病灶相比，破裂的病灶含有更高比例的红色血栓（75.9% vs. 43.3%，）。MT 后血栓负荷显着增加（69.6 mm ³ vs. 56.3 mm ³，)和 ELCA 更大程度地减少血栓（21.2 mm ³ vs. 11.8 mm ³，)在破裂的病灶中比未破裂的病灶中观察到。结论。即使在 MT 之后，ELCA 也能有效蒸发 STEMI 患者的冠状动脉内血栓。斑块破裂病变包含较大的血栓负荷，通常以红色血栓为特征，而 ELCA 可更有效地减少血栓负荷。