Embolism and Plaque - Cardiovascular Update

Novartis Reclaims Anthos, Reenters Factor XI Race

CardiacWire

FEBRUARY 12, 2025

Novartis initially prioritized its treatments for heart failure and plaque-clogged arteries when it spun-off abelacimab but continued to monitor the Factor XI race, leading to its choice to take the baton back from Anthos.

AFIB

AFIB Embolism Plaque Stroke

Abstract 42: Validation of a New Plaque-RADS Classification System to a Cohort of Embolic Stroke of Undetermined Source Patients

Stroke Journal

FEBRUARY 1, 2024

Introduction:A new Plaque-RADS classification (I-IV) is proposed to categorize the degree of carotid plaque instability and risk of embolic ischemic stroke. Carotid total plaque thickness and ulceration were scored by a neuroradiologist blinded to stroke side. N=188 plaques) met criteria.

Plaque

Plaque Embolism Stroke Strokes

HonorHealth Research Institute First in Southwest to Implant New Stroke Prevention Stent

DAIC

JUNE 4, 2024

The Neuroguard Integrated Embolic Protection (IEP) system is an experimental treatment for carotid artery stenosis, also known as carotid artery disease, a condition in which fatty-waxy deposits known as plaque builds up and blocks the normal flow of blood in the large arteries on either side of the neck.

Stents

Stents Stent Research Stroke

Webinars

Bridging Innovation & Patient Care: The Growing Role of AI

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Abstract TP176: Radiological Reporting Frequencies of High-Risk Non-Stenosing Carotid Plaque Features: A Follow-Up Observational Study

Stroke Journal

FEBRUARY 1, 2024

Background:High-risk non-stenosing carotid plaque features are emerging as a possible source of embolism in the setting of ESUS. We utilized Fisher’s exact test to compare the frequencies of reporting each plaque characteristic.Results:We analyzed 152 CTA reports in depth.

Plaque

Plaque Stenosis Embolism Stroke

Aortic Arch Plaques and the Long-Term Risk of Stroke and Cardiovascular Events in the Statin Era

Stroke Journal

DECEMBER 8, 2023

BACKGROUND:Aortic arch plaques are associated with an increased risk of ischemic stroke in patients with cryptogenic stroke or prior embolic events. Arch plaques were assessed by suprasternal transthoracic echocardiography; plaques ≥4 mm in thickness were classified as large plaques. Stroke, Ahead of Print.

Plaque

Plaque Aortic Stroke Strokes

Imaging Biomarkers and Prevalence of Complex Aortic Plaque in Cryptogenic Stroke: A Systematic Review

Journal of the American Heart Association

NOVEMBER 28, 2023

BackgroundComplex aortic plaque (CAP) is a potential embolic source in patients with cryptogenic stroke (CS). Most studies (74%) used ≥4 mm plaque thickness as the imaging criterion for CAP although ≥1 mm (N=1, CTA), ≥5 mm (N=5, TEE), and ≥6 mm (N=2, CTA) were also reported. 0.41],I2=94%). I2=95%) for TEE; 0.23 (95% CI, 0.15–0.34;I2=87%)

Plaque

Plaque Biomarkers Aortic Stroke

Evidence and Mechanisms for Embolic Stroke in Contralateral Hemispheres From Carotid Artery Sources

Journal of the American Heart Association

NOVEMBER 28, 2023

BackgroundDisambiguation of embolus pathogenesis in embolic strokes is often a clinical challenge. One common source of embolic stroke is the carotid arteries, with emboli originating due to plaque buildup or perioperatively during revascularization procedures.

Embolism

Embolism Stroke Strokes Plaque

Epidemiology, Pathophysiology, and Imaging of Atherosclerotic Intracranial Disease

Stroke Journal

JANUARY 21, 2024

The mechanisms by which ICAD causes stroke include plaque rupture with in situ thrombosis and occlusion or artery-to-artery embolization, hemodynamic injury, and branch occlusive disease.

Stenosis

Stenosis Thrombosis Dementia Embolism

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

MINOCA may be due to: coronary spasm, coronary microvascular dysfunction, plaque disruption, spontaneous coronary thrombosis/emboli , and coronary dissection; myocardial disorders, including myocarditis, takotsubo cardiomyopathy, and other cardiomyopathies. See "Mechanisms of acute coronary syndromes related to atherosclerosis".)

Coronary Angiogram

Coronary Angiogram Plaque Thrombosis STEMI

Concerning EKG with a Non-obstructive angiogram. What happened?

Dr. Smith's ECG Blog

DECEMBER 19, 2023

The commonest causes of MINOCA include: atherosclerotic causes such as plaque rupture or erosion with spontaneous thrombolysis, and non-atherosclerotic causes such as coronary vasospasm (sometimes called variant angina or Prinzmetal's angina), coronary embolism or thrombosis, possibly microvascular dysfunction.

Plaque

Plaque Angina Blog Stents

Elder Male with Syncope

EMS 12-Lead

APRIL 9, 2024

Sudden narrowing of a coronary artery due to ACS (plaque rupture with thrombosis and/or downstream showering of platelet-fibrin aggregates). This latter part has been implicated in embolic CVA. The underlying etiology is either Type 1 or Type II ischemia, although sometimes there’s overlap of both. Type I ischemia. Type II ischemia.

Ischemia

Ischemia Stenosis Chest Pain Coronary Artery Disease

Abstract 4140066: In ACS patients within 4 hours of pain to balloon time, the impact of no-reflow after PCI and ultrasound attenuation as detected by intravascular ultrasound on the incidence of no-reflow.

Circulation

NOVEMBER 11, 2024

A pathological classification of no-reflow was proposed: structural no-reflow—microvessels within the necrotic myocardium exhibit loss of capillary integrity (it is usually irreversible)—and functional no reflow—patency of microvasculature is compromised due to distal embolization, spasm, ischemic injury, reperfusion injury.

Ultrasound

Ultrasound Plaque Blood Pressure Myocardial Infarction

Understanding an Enlarged Heart (Cardiomegaly): Causes, Symptoms, and Treatment

MIBHS

OCTOBER 31, 2024

Coronary Artery Disease (CAD) CAD, which involves the narrowing or blockage of coronary arteries due to plaque buildup, can reduce blood flow to the heart. Blood Clots: An enlarged heart is more prone to developing blood clots, which can lead to stroke or pulmonary embolism.

Blood Pressure

Blood Pressure Blood Clot Heart Valves Heart Rhythm

Abstract 102: Microanatomy of Intracranial Human Thrombi by Single Nuclei Transcriptomics

Stroke Journal

FEBRUARY 1, 2024

Integration with carotid plaque data and diffusion coefficient analysis revealed shared transcriptional programs existing in a continuum, progressing from asymptomatic plaque to embolized thrombus.

Plaque

Plaque Embolism Stroke Strokes

Link Between Clonal Hematopoiesis and Stroke in Carotid Stenosis

All About Cardiovascular System and Disorders

MAY 22, 2024

About a fifth of all ischemic strokes are attributed to embolization of ruptured atherosclerotic plaque from carotid arterial stenosis. But it has been difficult to predict which person with asymptomatic carotid artery stenosis is likely to progress to symptomatic carotid disease and stroke.

Stenosis

Stenosis Stroke Strokes Risk Factors

1 hour of CPR, then ECMO circulation, then successful defibrillation.

Dr. Smith's ECG Blog

MAY 19, 2020

If the arrest was caused by acute MI due to plaque rupture, then the diagnosis is MINOCA. Here is my comment on MINOCA: "Non-obstructive coronary disease" does not necessarily imply "no plaque rupture with thrombus." They often cannot even be recognized as culprits, as fissured or ulcerated plaque. myocarditis).

Defibrillator

Defibrillator Circulation Plaque Cardiac Arrest

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Dr. Smith's ECG Blog

OCTOBER 10, 2022

As in all ischemia interpretations with OMI findings, the findings can be due to type 1 AMI (example: acute coronary plaque rupture and thrombosis) or type 2 AMI (with or without fixed CAD, with severe regional supply/demand mismatch essentially equaling zero blood flow). CT angiogram showed extensive saddle pulmonary embolism.

Cardiac Arrest

Cardiac Arrest Chest Pain Embolism Pulmonary

Abstract 4145631: A Rare Case of Sequential Impella Mechanical Failures due to Infective Endocarditis Vegetations

Circulation

NOVEMBER 11, 2024

Once stabilized, intravascular ultrasound showed significant thrombus and plaque in the LAD. Due to ongoing shock despite initial mechanical support, the patient was escalated to an Impella CP device after a transthoracic echo confirmed no left ventricle thrombus. This was treated with a drug-eluting stent, but TIMI 3 flow was not achieved.

Aortic valve

Aortic valve TAVR Chest Pain Aortic

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

To prove there is no plaque rupture, you need to do intravascular ultrasound (IVUS). An angiogram is a "lumenogram;" most plaque is EXTRALUMINAL!! One of the most common is rupture of a non-obstructive plaque, with thrombus formation and OMI that spontaneously lyses and leaves a wide open artery. It can only be seen by IVUS.

Plaque

Plaque Chest Pain Thrombosis Stenosis

Abstract TMP68: Proximal Balloon Occlusion With Forced Aspiration (POWER) Technique Should Be Effective in Preventing Distal Microembolization During Carotid Artery Stenting With the Filter Protection Device

Stroke Journal

FEBRUARY 1, 2024

We have developed a Proximal balloon Occlusion With forcEd aspiRation (POWER) technique to prevent distal embolization in CAS with the filter protection device. Purpose:Since the balloon protection device became unavailable in Japan three years ago, the DWI-positive rate after carotid artery stenting (CAS) has increased.

Stents

Stents Stent Stenosis Embolism

Abstract TMP72: Impaired Perfusion Predicts Early Recurrence in Symptomatic Intracranial Atherosclerosis

Stroke Journal

FEBRUARY 1, 2024

Background:Intracranial Atherosclerosis (ICAS) leads to stroke by perforator disease, artery to artery embolism, and impaired distal flow/perfusion. While medical treatment is likely to stabilize atherosclerotic plaques, it is unlikely to improve distal perfusion in the acute setting.

Atherosclerosis

Atherosclerosis Embolism Plaque Stroke

Abstract 127: Delayed Thrombectomy In A Patient With Recurrent MCA Strokes

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

MRI at the time showed an acute embolic infarct in left MCA territory, and a CTA showed a sub‐occlusive thrombus vs. atherosclerotic plaque in the superior branch of the left MCA. His first stroke was preceded by about 1 week of intermittent confusion and right arm tingling.

Stroke

Stroke Strokes Embolism Plaque

American College of Cardiology ACC.24 Late-breaking Science and Guidelines Session Summary

DAIC

FEBRUARY 29, 2024

ET Main Tent (Hall B1) Coronary Sinus Reducer for the Treatment of Refractory Angina: A Randomised, Placebo-controlled Trial (ORBITA-COSMIC) Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Patients at Low to Intermediate Risk: One Year Outcomes of the Randomized DEDICATE-DZHK6 Trial Effect of Alcohol-mediated Renal (..)

Aortic valve

Aortic valve Myocardial Infarction Aortic Blood Pressure

MINOCA : When a heart attack is not a heart attack

Dr. Sanjay Gupta

DECEMBER 19, 2022

She had some very minor plaque but certainly nothing that could explain the heart attack and therefore she was discharged with a diagnosis of MINOCA i.e She agreed and we performed an angiogram and we were fully expecting a blockage but interestingly there weren’t any.

Heart Attack

Heart Attack Heart attacks Blood Clot Chest Pain

A 30-something woman with intermittent CP, a HEART score of 2 and a Negative CT Coronary Angiogram on the same day

Dr. Smith's ECG Blog

MAY 10, 2023

LAD plaque with 0-25 percent stenosis. If there are T-wave inversions and elevated trops in the context of persistent pain, think of other pathologies such as pulmonary embolism. Now, with elevated troponins, Wellens' syndrome is likely. A CT Coronary angiogram was ordered. CAD-RADS category 1. --No Possibility #2: As per Dr.

Coronary Angiogram

Coronary Angiogram Chest Pain Stenosis STEMI

Is there a Right Ventricular MI in addition to Infero-postero-lateral MI?

Dr. Smith's ECG Blog

JULY 11, 2018

Today, they viewed the angiogram and concluded that the thrombus at the mid RCA must have extended proximally from the culprit ruptured plaque, extending proximal to the RV marginal branch and temporarily occluding it. However, by the time of the angiogram it had embolized distally, and had only done so after the right sided ECG was recorded.

Chest Pain

Chest Pain STEMI Ischemia Blog

A teenager with chest pain, a troponin below the limit of detection, and "benign early repolarization"

Dr. Smith's ECG Blog

JANUARY 9, 2023

CT angiogram chest: no aortic dissection or pulmonary embolism. Only after her troponin peaked at 500,000 ng/L did she get her angiogram, which showed a 100% left main occlusion due to ruptured plaque. No further troponins were measured. Serial chest xrays: progressive bilateral pulmonary edema. Diagnostic of Massive OMI.

Chest Pain

Chest Pain Aneurysm STEMI Thrombosis

Noisy, low amplitude ECG in a patient with chest pain

Dr. Smith's ECG Blog

JANUARY 15, 2024

Then, part of the thrombus embolized into the LCx causing an inferoposterolateral OMI. (As As an aside, the LCx OMI is a type 2 event, since it is due to supply-demand mismatch from thrombus, and not due to atherosclerotic plaque rupture or erosion). This resulted in anterior/apical infarct and apical thrombus formation.

Chest Pain

Chest Pain Blog Arrhythmia Critical Care

Prevalence of High-Risk CTA-Based Carotid Plaque-RADS Subtypes in Patients With Embolic Stroke of Undetermined Source

Stroke Journal

JANUARY 24, 2025

BACKGROUND:A modified computed tomography angiography (CTA)based Carotid Plaque Reporting and Data System (Plaque-RADS) classification was applied to a cohort of patients with embolic stroke of undetermined source to test whether high-risk Plaque-RADS subtypes are more prevalent on the ipsilateral side of stroke.

Plaque

Plaque Embolism Stroke Strokes

Sex-Specific Risk Factors of Nonstenotic Carotid Plaque in Embolic Stroke of Unknown Source: A Case-Control Study

Stroke Journal

DECEMBER 28, 2023

BACKGROUND:Many ischemic strokes are diagnosed as embolic strokes of undetermined source (ESUS). Recent evidence suggests that nonstenotic carotid plaque (nsCP) may be a substantial contributor to the risk for ESUS. Stroke, Ahead of Print.

Risk Factors

Risk Factors Plaque Embolism Stroke

Pay now (in the evening) or pay later with interest (in the middle of the night).

Dr. Smith's ECG Blog

MARCH 1, 2025

Angiogram: --"Suspected culprit for the patient's non-ST elevation myocardial infarction with refractory chest discomfort (although it had resolved prior to arrival to the cardiac catheterization lab), is a ruptured plaque in the distal circumflex with local embolic occlusion of the distal OM 3."

Chest Pain

Chest Pain STEMI Stents Stent

Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

Dr. Smith's ECG Blog

MARCH 8, 2025

Third, a slow motion segment showing delayed, brisk filling of the PDA due to dislodgment of a thrombus from contrast injection and distal embolization. A distal RCA lesion ( blue arrow ), Delayed brisk filling of an initially occluded PDA due to a thrombus dislodged during injection which embolized distally. link] Bentzon, J.

Cardiomyopathy

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia

Can you localize the culprit lesion on angiogram without taking ECG findings into account?

Dr. Smith's ECG Blog

MARCH 25, 2025

And it is definitely possible that a more proximal LCx lesion ruptured and produced distal embolism. And in a study like COMPLETE or MULTISTARS AMI, you are stenting an acute plaque rupture (the culprit) and non-ruptured, non-culprit and hence essentially stable plaques. Some others worried about the RCA as a possible culprit.

Chest Pain

Chest Pain Ischemia Plaque Stents

Novartis Reclaims Anthos, Reenters Factor XI Race

Abstract 42: Validation of a New Plaque-RADS Classification System to a Cohort of Embolic Stroke of Undetermined Source Patients

HonorHealth Research Institute First in Southwest to Implant New Stroke Prevention Stent

Webinars

Abstract TP176: Radiological Reporting Frequencies of High-Risk Non-Stenosing Carotid Plaque Features: A Follow-Up Observational Study

Aortic Arch Plaques and the Long-Term Risk of Stroke and Cardiovascular Events in the Statin Era

Imaging Biomarkers and Prevalence of Complex Aortic Plaque in Cryptogenic Stroke: A Systematic Review

Evidence and Mechanisms for Embolic Stroke in Contralateral Hemispheres From Carotid Artery Sources

Epidemiology, Pathophysiology, and Imaging of Atherosclerotic Intracranial Disease

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

Concerning EKG with a Non-obstructive angiogram. What happened?

Elder Male with Syncope

Abstract 4140066: In ACS patients within 4 hours of pain to balloon time, the impact of no-reflow after PCI and ultrasound attenuation as detected by intravascular ultrasound on the incidence of no-reflow.

Understanding an Enlarged Heart (Cardiomegaly): Causes, Symptoms, and Treatment

Abstract 102: Microanatomy of Intracranial Human Thrombi by Single Nuclei Transcriptomics

Link Between Clonal Hematopoiesis and Stroke in Carotid Stenosis

1 hour of CPR, then ECMO circulation, then successful defibrillation.

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Abstract 4145631: A Rare Case of Sequential Impella Mechanical Failures due to Infective Endocarditis Vegetations

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Abstract TMP68: Proximal Balloon Occlusion With Forced Aspiration (POWER) Technique Should Be Effective in Preventing Distal Microembolization During Carotid Artery Stenting With the Filter Protection Device

Abstract TMP72: Impaired Perfusion Predicts Early Recurrence in Symptomatic Intracranial Atherosclerosis

Abstract 127: Delayed Thrombectomy In A Patient With Recurrent MCA Strokes

American College of Cardiology ACC.24 Late-breaking Science and Guidelines Session Summary

MINOCA : When a heart attack is not a heart attack

A 30-something woman with intermittent CP, a HEART score of 2 and a Negative CT Coronary Angiogram on the same day

Is there a Right Ventricular MI in addition to Infero-postero-lateral MI?

A teenager with chest pain, a troponin below the limit of detection, and "benign early repolarization"

Noisy, low amplitude ECG in a patient with chest pain

Prevalence of High-Risk CTA-Based Carotid Plaque-RADS Subtypes in Patients With Embolic Stroke of Undetermined Source

Sex-Specific Risk Factors of Nonstenotic Carotid Plaque in Embolic Stroke of Unknown Source: A Case-Control Study

Pay now (in the evening) or pay later with interest (in the middle of the night).

Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

Can you localize the culprit lesion on angiogram without taking ECG findings into account?

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