2024 Scientific Sessions

Title:
Intracoronary clot busters

Introduction:
It is a case of myocardial infarction which was treated with intracoronary thrombolysis after failed manual aspiration which improved flow and helped optimise percutaneous coronary intervention.

Clinical Case:
55-year-old man admitted with late presenting Inferior STEMI. He is an ex-smoker. ECG showed inferior ST elevation, no Q waves. ECHO: Normal size left ventricle with systolic function. EF 58%. No RWMA. His coronary angiogram showed RCA is the culprit with extensive thrombus. We attempted manual aspiration which failed and we trialled intracoronary Alteplase which improved flow. This case discussed on drug coated balloon as a possible option for STEMI and intracoroanry thrombolysis when manual aspiration fails.

Discussion:

• Unresolved intracoronary thrombi can cause microvascular obstruction, known as the no-reflow phenomenon, and result in reduced myocardial perfusion at the microvascular level, increased infarct size and higher mortality.
• Larger intracoronary thrombus burden correlates with greater infarct size, distal embolization and propagates stent thrombosis, with subsequent increase in major adverse cardiac events.
• This case demonstrates that intracoronary rt-PA can result in local thrombus reduction in patients undergoing PCI.
• There was complete reperfusion on repeat angiography 2 months later with TIMI grade 3 flow.
• Catheter-directed intracoronary thrombolysis can be performed effectively and safely in patients with high thrombotic burden.
• In patients with high thrombotic burden and and failed manual aspiration, administration of low dose intracoronary thrombolysis improves epicardial flow and myocardial reperfusion by reducing thrombotic burden.
• Intracoronary thrombolysis has a role as an adjunct therapy in highly selected cases in the setting of ST-elevation myocardial infarction, particularly with large thrombus burden, to facilitate revascularization.