Two-Stage Revascularization in Patients with Acute Myocardial Infarction and Massive Coronary Thrombosis

Abstract

Aim:to investigate safety and angiographic efficacy of two-stage revascularization with percutaneous coronary intervention (PCI) with stenting delayed by one day in patients with acute myocardial infarction (MI) and massive coronary thrombosis.Materials and methods.We included in this study 12 patients with massive infarct related coronary artery thrombus which length was greater than thrice the vessel diameter in the presence of TIMI grade II–III blood flow as detected by coronary angiography (CAG). The emergency PCI was not performed, and conservative antithrombotic therapy continued for 24 hours. After this day, CAG was repeated.Results.Repeat CAG in all patients showed thrombus regression which visually appeared as complete lysis in 8, and partial lysis – in 4 patients. Stenting of residual stenosis was performed in 11 patients without complications. In 1 patient residual stenosis was considered insignificant (<50 %) therefore stenting was not performed. No-reflowphenomenon and recurrent MI were not observed.Conclusion.These data suggest that in patients with massive coronary artery thrombosis conservative antithrombotic therapy for 24 hours followed by repeated CAG and, if required, by stenting of residual stenosis, is safe treatment tactics that might reduce the risk of the no-reflow phenomenon.

Thrombus aspiration in patients with ST-segment elevation myocardial infarction: a literature review

“…Основным патогенетическим механизмом "no-ref low" считают микроэмболию фрагментами тромба или атеросклеротической бляшки дистального русла, возникающую при баллонной дилатации или стентировании коронарной артерии. Все это приводит к снижению коронарного резерва, увеличению дистального сосудистого сопротивления, активации местной реакции воспаления с выделением эндотелина-1 и тромбоксана-А2, запуском процесса нетоза в нейтрофилах (вид программируемой клеточной гибели нейтрофилов с выделением цитотоксичных по отношению к окружающим тканям внеклеточных ловушек, или NET -neutrophil extracellular traps) и последующим снижением перфузии миокарда [7][8][9]. Согласно имеющимся данным, частота данного феномена при экстренной ЧКВ достигает 20-37% [10].…”