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Cardiac
Diagnosis
Coronary Artery Disease
Coronary Thrombosis
Coronary Thrombosis
Stephan Achenbach, MD, FESC, FACC, FSCCT
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Obstruction/occlusion of coronary artery by thrombus
              • Usually consequence of plaque rupture

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Intracoronary Imaging Findings

                  • Echocardiographic Findings

                    • Angiographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            Selected References

                                            1. Benjamin EJ et al: Heart disease and stroke statistics-2018 update: A report from the American Heart Association. Circulation. 137(12):e67-e492, 2018
                                            2. Go AS et al: Executive summary: heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation. 127(1):143-52, 2013
                                            3. Goyal P et al: Cardiovascular magnetic resonance imaging for assessment of cardiac thrombus. Methodist Debakey Cardiovasc J. 9(3):132-6, 2013
                                            4. Narula J et al: Histopathologic characteristics of atherosclerotic coronary disease and implications of the findings for the invasive and noninvasive detection of vulnerable plaques. J Am Coll Cardiol. 61(10):1041-51, 2013
                                            5. Finkel JB et al: Rethinking cocaine-associated chest pain and acute coronary syndromes. Mayo Clin Proc. 86(12):1198-207, 2011
                                            6. Jansen CH et al: Detection of intracoronary thrombus by magnetic resonance imaging in patients with acute myocardial infarction. Circulation. 124(4):416-24, 2011
                                            7. Finn AV et al: Concept of vulnerable/unstable plaque. Arterioscler Thromb Vasc Biol. 30(7):1282-92, 2010
                                            8. Huang WC et al: Comparing culprit lesions in ST-segment elevation and non-ST-segment elevation acute coronary syndrome with 64-slice multidetector computed tomography. Eur J Radiol. 73(1):74-81, 2010
                                            9. Tanaka A et al: Non-invasive assessment of plaque rupture by 64-slice multidetector computed tomography--comparison with intravascular ultrasound. Circ J. 72(8):1276-81, 2008
                                            10. Motoyama S et al: Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol. 50(4):319-26, 2007
                                            11. Hoffmann U et al: Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography. J Am Coll Cardiol. 47(8):1655-62, 2006
                                            12. Libby P et al: Pathophysiology of coronary artery disease. Circulation. 111(25):3481-8, 2005
                                            13. Botnar RM et al: In vivo magnetic resonance imaging of coronary thrombosis using a fibrin-binding molecular magnetic resonance contrast agent. Circulation. 110(11):1463-6, 2004
                                            14. Koiwaya Y et al: Angiographic features at ischemia- or infarct-related sites in patients with acute coronary syndrome: morphology changing in a relatively short time. J Cardiol. 38(4):187-96, 2001
                                            15. Goldstein JA et al: Multiple complex coronary plaques in patients with acute myocardial infarction. N Engl J Med. 343(13):915-22, 2000
                                            16. Badimon L et al: Thrombus formation on ruptured atherosclerotic plaques and rethrombosis on evolving thrombi. Circulation. 86(6 Suppl):III74-85, 1992
                                            17. Rehr RB et al: Thrombosis in unstable angina: angiographic aspects. Cardiovasc Clin. 18(1):183-94, 1987
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Definitions

                                                      • Obstruction/occlusion of coronary artery by thrombus
                                                        • Usually consequence of plaque rupture

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • Intracoronary Imaging Findings

                                                            • Echocardiographic Findings

                                                              • Angiographic Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Staging, Grading, & Classification

                                                                        • Gross Pathologic & Surgical Features

                                                                          • Microscopic Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Consider

                                                                                      Selected References

                                                                                      1. Benjamin EJ et al: Heart disease and stroke statistics-2018 update: A report from the American Heart Association. Circulation. 137(12):e67-e492, 2018
                                                                                      2. Go AS et al: Executive summary: heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation. 127(1):143-52, 2013
                                                                                      3. Goyal P et al: Cardiovascular magnetic resonance imaging for assessment of cardiac thrombus. Methodist Debakey Cardiovasc J. 9(3):132-6, 2013
                                                                                      4. Narula J et al: Histopathologic characteristics of atherosclerotic coronary disease and implications of the findings for the invasive and noninvasive detection of vulnerable plaques. J Am Coll Cardiol. 61(10):1041-51, 2013
                                                                                      5. Finkel JB et al: Rethinking cocaine-associated chest pain and acute coronary syndromes. Mayo Clin Proc. 86(12):1198-207, 2011
                                                                                      6. Jansen CH et al: Detection of intracoronary thrombus by magnetic resonance imaging in patients with acute myocardial infarction. Circulation. 124(4):416-24, 2011
                                                                                      7. Finn AV et al: Concept of vulnerable/unstable plaque. Arterioscler Thromb Vasc Biol. 30(7):1282-92, 2010
                                                                                      8. Huang WC et al: Comparing culprit lesions in ST-segment elevation and non-ST-segment elevation acute coronary syndrome with 64-slice multidetector computed tomography. Eur J Radiol. 73(1):74-81, 2010
                                                                                      9. Tanaka A et al: Non-invasive assessment of plaque rupture by 64-slice multidetector computed tomography--comparison with intravascular ultrasound. Circ J. 72(8):1276-81, 2008
                                                                                      10. Motoyama S et al: Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol. 50(4):319-26, 2007
                                                                                      11. Hoffmann U et al: Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography. J Am Coll Cardiol. 47(8):1655-62, 2006
                                                                                      12. Libby P et al: Pathophysiology of coronary artery disease. Circulation. 111(25):3481-8, 2005
                                                                                      13. Botnar RM et al: In vivo magnetic resonance imaging of coronary thrombosis using a fibrin-binding molecular magnetic resonance contrast agent. Circulation. 110(11):1463-6, 2004
                                                                                      14. Koiwaya Y et al: Angiographic features at ischemia- or infarct-related sites in patients with acute coronary syndrome: morphology changing in a relatively short time. J Cardiol. 38(4):187-96, 2001
                                                                                      15. Goldstein JA et al: Multiple complex coronary plaques in patients with acute myocardial infarction. N Engl J Med. 343(13):915-22, 2000
                                                                                      16. Badimon L et al: Thrombus formation on ruptured atherosclerotic plaques and rethrombosis on evolving thrombi. Circulation. 86(6 Suppl):III74-85, 1992
                                                                                      17. Rehr RB et al: Thrombosis in unstable angina: angiographic aspects. Cardiovasc Clin. 18(1):183-94, 1987