Key result
Intracoronary thrombolysis with low-dose tenecteplase and a stentless strategy successfully restored TIMI 3 flow in a STEMI patient with an ectatic artery and large thrombus burden.
Why the study?
Does intracoronary thrombolysis with low-dose tenecteplase and a stentless strategy improve coronary flow in a patient with STEMI, ectatic RCA, and large thrombus burden failing manual thrombectomy?
Case Report (n=1)
No
Does intracoronary thrombolysis with low-dose tenecteplase and a stentless strategy improve coronary flow in a patient with STEMI, ectatic RCA, and large thrombus burden failing manual thrombectomy?
Intracoronary thrombolysis with low-dose tenecteplase and a stentless strategy may be an effective approach for STEMI patients with ectatic arteries and large thrombus burden when manual thrombectomy fails.
May offer bailout in refractory ectatic STEMI; hypothesis-generating and requires prospective validation.
A 58-year-old man was admitted to our center with an inferior ST-segment elevation myocardial infarction. A coronary angiogram showed an ectatic right coronary artery (RCA) occluded at mid vessel by a significant clot burden quantified by micro-computed tomography. Guide catheter-directed intracoronary thrombolysis with low-dose tenekteplase resulted in regaining RCA flow, when numerous efforts of manual and 'mother-child' thrombectomy had failed to achieve. A stentless strategy was followed with final thrombolysis in myocardial infarction 3 flow and angiographically insignificant stenosis remaining in the RCA. The combination of intracoronary thrombolysis and a stentless strategy is a safe and effective treatment in ST-segment elevation myocardial infarction patients with ectatic arteries and large thrombus burden when repeat manual aspiration thrombectomy fails.
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Kassimis et al. (2020) conducted a case report in ST-segment elevation myocardial infarction (n=1). Intracoronary thrombolysis and stentless primary percutaneous coronary intervention was evaluated on Regaining RCA flow (TIMI 3 flow). Intracoronary thrombolysis with low-dose tenecteplase and a stentless strategy successfully restored TIMI 3 flow in a STEMI patient with an ectatic artery and large thrombus burden.
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