TY - JOUR
T1 - The role of intracoronary thrombolysis in thrombus-laden coronary artery
T2 - a case report
AU - Suryawan, I. Gde Rurus
AU - Muhammad, Rizal
AU - Triastuti, Fita
N1 - Publisher Copyright:
© 2024 SOLEN s.r.o.. All rights reserved.
PY - 2024
Y1 - 2024
N2 - Introduction: Large intracoronary thrombus in patients presenting with ST elevation myocardial infarction (STEMI) can cause distal embolization, the no-reflow phenomenon, and stent thrombosis. Approximately 10% of patients undergoing primary percutaneous coronary intervention (PCI) have distal embolization of thrombus, causing coronary microvascular obstruction and reduced myocardial tissue perfusion. This can lead to ongoing ischemia, a larger infarct size, and a significant increase in 30-day mortality, regardless of successful PCI with normal epicardial vessel flow. Case Presentation: A 51-year-old Asian male presented with STEMI. Coronary angiography revealed a large thrombus totally occluding the proximal portion of the right coronary artery (RCA). Catheter-directed intracoronary thrombolysis with streptokinase was performed after multiple attempts at manual aspiration thrombectomy (MAT) and balloon angioplasty had failed to achieve coronary blood flow recovery. After successful stenting, a diffuse residual thrombus remained in the RCA. Evaluation angiography of the RCA performed four days later showed complete thrombus dissolution with thrombolysis in myocardial infarction (TIMI) grade 3 flow. Discussion: While there is no gold-standard therapy to deal with intracoronary thrombus, there are combinations of both pharmacological and mechanical therapies that can be utilized. MAT should not be used routinely in STEMI, but may be helpful in selected cases. Catheter-directed intracoronary thrombolysis can be a safe and effective alternative reperfusion strategy when MAT alone fails to achieve sufficient coronary blood flow in the thrombotic infarct-related artery (IRA). Conclusion: The management of intracoronary thrombus during PCI remains a therapeutic challenge, and an aggressive, case-by-case, tailored approach can lead to improved outcomes.
AB - Introduction: Large intracoronary thrombus in patients presenting with ST elevation myocardial infarction (STEMI) can cause distal embolization, the no-reflow phenomenon, and stent thrombosis. Approximately 10% of patients undergoing primary percutaneous coronary intervention (PCI) have distal embolization of thrombus, causing coronary microvascular obstruction and reduced myocardial tissue perfusion. This can lead to ongoing ischemia, a larger infarct size, and a significant increase in 30-day mortality, regardless of successful PCI with normal epicardial vessel flow. Case Presentation: A 51-year-old Asian male presented with STEMI. Coronary angiography revealed a large thrombus totally occluding the proximal portion of the right coronary artery (RCA). Catheter-directed intracoronary thrombolysis with streptokinase was performed after multiple attempts at manual aspiration thrombectomy (MAT) and balloon angioplasty had failed to achieve coronary blood flow recovery. After successful stenting, a diffuse residual thrombus remained in the RCA. Evaluation angiography of the RCA performed four days later showed complete thrombus dissolution with thrombolysis in myocardial infarction (TIMI) grade 3 flow. Discussion: While there is no gold-standard therapy to deal with intracoronary thrombus, there are combinations of both pharmacological and mechanical therapies that can be utilized. MAT should not be used routinely in STEMI, but may be helpful in selected cases. Catheter-directed intracoronary thrombolysis can be a safe and effective alternative reperfusion strategy when MAT alone fails to achieve sufficient coronary blood flow in the thrombotic infarct-related artery (IRA). Conclusion: The management of intracoronary thrombus during PCI remains a therapeutic challenge, and an aggressive, case-by-case, tailored approach can lead to improved outcomes.
KW - intracoronary streptokinase
KW - intracoronary thrombus
KW - manual aspiration thrombectomy (MAT)
KW - primary percutaneous coronary intervention (PCI)
KW - ST-elevation myocardial infarction (STEMI)
UR - http://www.scopus.com/inward/record.url?scp=85193343714&partnerID=8YFLogxK
U2 - 10.36290/kar.2024.002
DO - 10.36290/kar.2024.002
M3 - Article
AN - SCOPUS:85193343714
SN - 1213-807X
VL - 23
SP - 43
EP - 49
JO - Intervencni a Akutni Kardiologie
JF - Intervencni a Akutni Kardiologie
IS - 1
ER -