Читать книгу Interventional Cardiology - Группа авторов - Страница 251

Peri‐procedural myocardial infarction can be related to distal embolization of LCP component, contents, and/or intracoronary thrombus. In a sub‐study of COLOR (Chemometric Observation of Lipid Core Plaques of Interest in Native Coronary Arteries) registry, the cardiac biomarkers in 62 stable patients undergoing stenting were evaluated. Findings revealed that 7 out of 14 (50%) patients with a maxLCBI_4mm ≥500 developed peri‐procedural myocardial infarction in comparison with the occurrence of this in only 2 out of 48 (4.2%) patients with a < maxLCBI_4mm [129]. In a study by Raghunathan et al. [130], in which a creatinine kinase‐MB increase >3 times the upper normal limit was observed in 27% of patients with a ≥1 yellow block as opposed to none of the patients without a yellow block within the stented lesion. Similarly, in the CANARY (Coronary Assessment by Near‐infrared of Atherosclerotic Rupture‐prone Yellow) trial, patients with periinterventional myocardial infarction had higher maxLCBI_4mm than patients without MI [131]. However, preventive measures for this situation remain uncertain. The use of a distal emboli protection device frequently resulted in embolized material retrieval during intervention in a small group of patients with LCP [132]; however, there was no benefit of this adjunctive treatment in the randomized CANARY trial.

A prospective use of NIRS in catheterization laboratories is in stent sizing to ensure adequate lesion coverage. Visual evaluation of lesions by angiography occasionally lack accuracy and using NIRS, Dixon et al. [133] demonstrated that in 16% of the lesions assessed in their study, the LCP extended beyond the angiographic margins of the initial target lesion. Therefore, together with the information provided by IVUS, NIRS data can be used for determining the size and length of the artery to be stented.