Is Stent Implantation Always Necessary in Acute Coronary Syndromes Caused by Unstable Plaque?

Using intravascular imaging, researchers show that these plaques may be safely treated “conservatively,” but there are serious concerns with the study and its results.

In a prospective, uncontrolled, observational study in China, researchers sought to test the feasibility of using antithrombotics (dual antiplatelet therapy and heparin; heparin ended 3 days postcatheterization) but no stenting in patients with acute coronary syndromes (ACS) caused by plaque erosion. Of 405 ACS patients with analyzable optical coherence therapy (OCT) images, 103 patients (25%) had plaque erosion (ST-elevation myocardial infarction [STEMI], 97%; non–ST-elevation ACS, 3%).

Sixty patients were treated conservatively; 5 were lost to follow-up; 51 patients underwent manual thrombectomy. From baseline to 1 month, median thrombus volume decreased from 3.7 mm³ to 0.2 mm³; median flow area increased from 1.7 mm² to 2.1 mm². One patie…

Reviewing Author

Pascal Meier, MD

Disclosures

Editorial BoardsOpen Heart

Leadership Positions in Professional SocietiesEuropean Society of Cardiology (Communication Committee); European Association of Percutaneous Cardiovascular Interventions (Chair, Web & Communication Committee)

Pascal Meier, MD

Disclosures

Editorial BoardsOpen Heart

Is Stent Implantation Always Necessary in Acute Coronary Syndromes Caused by Unstable Plaque?

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Reviewing Author