Diagnosis and Management of Spontaneously Recanalized Coronary Thrombus Guided by Optical Coherence Tomography　― Lessons From the French “Lotus Root” Registry ―

Géraud Souteyrand; Mathieu Valladier; Nicolas Amabile; François Derimay; Brahim Harbaoui; Pierre Leddet; Pierre Barnay; Guilhem Malcles; Aurelien Mulliez; Colin Berry; Romain Eschalier; Nicolas Combaret; Pascal Motreff

doi:10.1253/circj.CJ-17-0810

Ischemic Heart Disease

Diagnosis and Management of Spontaneously Recanalized Coronary Thrombus Guided by Optical Coherence Tomography　― Lessons From the French “Lotus Root” Registry ―

Géraud Souteyrand, Mathieu Valladier, Nicolas Amabile, François Derimay, Brahim Harbaoui, Pierre Leddet, Pierre Barnay, Guilhem Malcles, Aurelien Mulliez, Colin Berry, Romain Eschalier, Nicolas Combaret, Pascal Motreff

Author information

Géraud Souteyrand
Cardiology Department, CHU Clermont-Ferrand, CNRS, University of Clermont Auvergne (UCA)
ISIT-CAVITI, UMR 6284, University of Clermont Auvergne (UCA)
Mathieu Valladier
Cardiology Department, CHU Clermont-Ferrand, CNRS, University of Clermont Auvergne (UCA)
ISIT-CAVITI, UMR 6284, University of Clermont Auvergne (UCA)
Nicolas Amabile
Cardiology Department, Institut Mutualiste Montsouris
François Derimay
Cardiology Department, Bron University Hospital Center
Brahim Harbaoui
Cardiology Department, Lyon La Croix Rousse Hospital Center
Pierre Leddet
Cardiology Department, Haguenau Hospital Center
Pierre Barnay
Cardiology Department, Avignon Hospital Center
Guilhem Malcles
Cardiology Department, CHU Clermont-Ferrand, CNRS, University of Clermont Auvergne (UCA)
ISIT-CAVITI, UMR 6284, University of Clermont Auvergne (UCA)
Aurelien Mulliez
Biostatistics Unit, University of Clermont Auvergne (UCA)
Colin Berry
Institute of Cardiovascular and Medical Sciences, University of Glasgow
Romain Eschalier
Cardiology Department, CHU Clermont-Ferrand, CNRS, University of Clermont Auvergne (UCA)
ISIT-CAVITI, UMR 6284, University of Clermont Auvergne (UCA)
Nicolas Combaret
Cardiology Department, CHU Clermont-Ferrand, CNRS, University of Clermont Auvergne (UCA)
ISIT-CAVITI, UMR 6284, University of Clermont Auvergne (UCA)
Pascal Motreff
Cardiology Department, CHU Clermont-Ferrand, CNRS, University of Clermont Auvergne (UCA)
ISIT-CAVITI, UMR 6284, University of Clermont Auvergne (UCA)

Keywords: Optical coherence tomography, Recanalized coronary thrombus

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2018 Volume 82 Issue 3 Pages 783-790

DOI https://doi.org/10.1253/circj.CJ-17-0810

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Abstract

Background:Spontaneous reanalyzed coronary thrombus (SRCT) has been reported in autopsy series, but little is known about SRCT, and it is potentially under-diagnosed in clinical practice.

Methods and Results:SRCT identified on OCT were included in a French multicenter series, the Lotus Root French Registry. A total of 34 SRCT were identified on OCT in 33 patients (23 male; median age, 56 years; IQR, 52–65 years); 23/33 patients (70%) presented with angina pectoris and/or dyspnea. Three angiographic aspects were distinguished retrospectively: braided, pseudo-dissected, and hazy. Stenosis severity on quantitative coronary analysis varied between 11% and 100% (median, 45%), whereas the reduction in lumen area on OCT varied between 20% and 92% (median, 68%). A typical “lotus root” aspect was confirmed on OCT, consisting of multiple circular concave-edged channels of varying size, numbering between 3 and 12 depending on the slice, separated by smooth-edged septa of high luminosity without posterior attenuation. OCT also served to guide treatment, with stenting in 91% of cases. During the 17-month follow-up 91% of patients had excellent evolution. One death and 3 ACS events occurred.

Conclusions:In this large SRCT cohort, angiography had limited diagnostic value whereas OCT could be used to define disease characteristics and guide treatment of lesions inducing angina pectoris and/or silent myocardial ischemia. OCT-guided management was associated with good prognosis.

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