%0 Journal Article
%T Intravascular ultrasound to guide the management of intracoronary thrombus: a Case Report
%A Italo Porto
%A Andrew RJ Mitchell
%A Vaishali Ashar
%A Adrian P Banning
%J Cardiovascular Ultrasound
%D 2004
%I BioMed Central
%R 10.1186/1476-7120-2-18
%X We discuss the role of intravascular imaging to guide the use of a distal protection device by describing the outcome of a young woman presenting with non-ST elevation myocardial infarction. Coronary angiography demonstrated an isolated minor stenosis in the proximal left anterior descending coronary artery with slight haziness beyond the lesion. Intravascular ultrasound confirmed an extensive thrombus overlying a bulky atherosclerotic plaque. A distal filter wire was therefore successfully used to reduce the risk of distal embolization.The use of intravascular ultrasound in patients presenting with acute coronary syndrome may reveal large thrombi that are difficult to image using conventional angiographic techniques. Intravascular ultrasound can therefore be used as a tool to select lesions requiring distal protection.Patients with acute coronary syndromes (ACS) are increasingly treated with an early invasive strategy. During percutaneous coronary interventions (PCI) interventionalists have often to deal with thrombus-laden lesions in native coronary vessels. This poses the serious problem of preventing macroscopic and microscopic distal embolization [1]. There have been many recent advances in this field, and new tools are available for shielding the distal microvasculature, including occlusive systems and basket filters. In the very emboli-prone saphenous vein grafts interventions, for example, both techniques have been associated with favourable results [2,3].In native vessels cost and efficacy [4] considerations prompt a careful use of these devices, and a sensible approach could be selecting lesion and patients at high risk of distal embolization. For example, preventing distal embolization is particularly important in young patients presenting with their first coronary event with a large thrombotic burden [5,6].Angiography alone is known to underestimate the risk of distal embolization: for example, only overt signs of massive thrombus burden are predictive o
%K intravascular ultrasound
%K thrombus
%K stent
%U http://www.cardiovascularultrasound.com/content/2/1/18