De Maria GL., Banning AP.
Atherosclerotic plaque disruption is a key event in the pathophysiology of acute coronary syndromes (ACS). Intraluminal thrombus is probably a universal feature of ACS as it is predominantly responsible for the accelerated process of vessel occlusion or subocclusion that characterizes the spectrum of ACS, from ST elevation ACS to non-ST-elevation ACS. This chapter describes an interventional approach to managing thrombus-containing coronary lesions. Intracoronary intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have higher sensitivity and specificity than angiography and allow better thrombus definition, quantification, and characterization. Two main kinds of thrombectomy devices are available: manual and mechanical. Manual thrombus aspiration devices consist of 6 Fr compatible dual lumen catheters. Two parameters determine the efficacy of a manual thrombectomy: deliverability and aspiration rate. With mechanical thrombectomy devices the thrombus is first lysed before extraction. Excimer laser coronary angioplasty (ELCA) is used to reduce thrombotic burden.