Key result
Low-dose intracoronary alteplase may restore flow in STEMI with high thrombus burden after failed aspiration.
Why the study?
High thrombus burden in patients with acute STEMI is related to post-operative complications, adverse effects, and worse prognosis.
Case Report (n=2)
No
Low-dose intracoronary fibrinolytic therapy may be a useful strategy to restore flow in STEMI patients with high thrombus burden and no-reflow when manual thrombus aspiration fails.
Answers are grounded in this paper and cite their sources.
Hypothesis-generating for low-dose intracoronary alteplase in refractory high-thrombus STEMI; randomized trials needed before adoption.
Introduction: High thrombus burden (HTB) in patients presenting with acute ST segment elevation myocardial infarction (STEMI) is related to post-operative complications, adverse effects and worse prognosis. Case reports: We present two similar patients presenting with STEMI, in whom we used two different strategies to cope with HTB after failed manual thrombus aspirations: in the first case we did immediate stenting of infarct related artery (IRA); in the second case, after persisting of noreflow phenomenon, despite implantation of two stents, we decided to intracoronary administer low-dose alteplase. Conclusion: Aldo still controversial, evidence suggest that low-dose intracoronary fibrinolytic therapy could be useful in patients presenting with HTB, especially when manual thrombus aspiration have failed. The experience from our center confirms those statements.
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Zdravković et al. (2021) conducted a case report in ST-segment elevation myocardial infarction (STEMI) with high thrombus burden (n=2). Intracoronary low-dose alteplase and immediate stenting was evaluated on Restoration of coronary flow (TIMI flow grade). Low-dose intracoronary alteplase successfully restored coronary flow in a STEMI patient with high thrombus burden and no-reflow phenomenon after failed manual aspiration and stenting.
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