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Figure 1. Histopathology of a cross-section of a heavy burden occlusive coronary thrombus. T: Thrombus. Image courtesy of Shannon Mackey-Bojack, Jesse Edwards Registry of Cardiovascular Disease, Nasseff Heart Center, United Hospitals, University of Minnesota School of Medicine, St Paul, MN, USA.
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Figure 2. Thrombolysis in myocardial infarction grade 5 thrombus in the circumflex artery. (A) Coronary angiogram demonstrating a target vessel containing a large thrombus burden. This angiogram was obtained pre-application of Siano's restratification of grade 5. (B) Restratification of the thrombolysis in myocardial infarction grade 5 thrombus following guide wire crossing of the thrombus. As the guide wire recanalized the thrombotic occlusion antegrade flow was established demonstrating a low residual thrombus burden. The restratification in this case enabled a decision to continue with direct stenting.
(C) Final agiographic view post-adjunct stenting.
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Figure 3. Thrombolysis in myocardial infarction thrombus grade 1. The angiographic features are suggestive of thrombus.
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Figure 4. Thrombolysis In myocardial infarction thrombus grade 2. The thrombus accompanies an eccentric middle right coronary artery lesion.
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Figure 5. Bi-level grading classification: a low thrombus grade in a saphenous vein graft.
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Figure 6. Bi-level grading classification: a high thrombus grade in a saphenous vein graft.
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Determining the appropriate management for patients with acute and chronic ischemic coronary syndromes requires careful assessment of the risk of mortality and adverse ischemic events [1]. The morphology of the targeted plaque and its composites needs to be taken into consideration once a decision has been made to proceed with percutaneous coronary intervention (PCI). Thrombus are an integral component of atherosclerotic coronary plaques, which are frequently encountered in patients with unstable angina and acute myocardial infarction (AMI) [2,3]. There is a consensus that the presence of intracoronary thrombus constitutes a challenging target for revascularization because of its unique physical properties and pathologic vascular characteristics. Due to the crucial impact of thrombus on the performance and the outcome of PCI, the quest for an optional treatment for thrombotic lesions continues [4]. To date, thrombus remains a strong predictor of PCI-induced major adverse coronary events, development of acute and late stent...