ACS

Concept: Most acute coronary syndromes (ACS) are caused by the rupture of thin-capped fibroatheromas (TCFAs). TFCAs are characterized by a large necrotic lipid core, a thin intimal cap (<100 μm), and minimal protrusion into the lumen. TCFAs can be reliable visualized by optical coherence tomography (OCT). Complicating ACS prevention though is the inability to identify the small percentage (less than 20%) of TCFAs that lead to ACS. Therefore, lesion specific intervention can't currently be performed. In this paper, we propose that ACS occurs with those TCFAs in close proximity or contiguous with a necrotic core or ‘shaft'. On TCFA rupture, blood forces evacuation of the large volume, deep thrombogenic shaft. The release of the core back into the lumen occurs downstream from the TCFA. The burden of the large volume thrombogenic material entering the lumen (not from the TCFA but the shaft) results in catastrophic clot formation. Case studies supporting this conclusion are presented. This..

Primary location: Boston