Key result
Deferred stenting after potent antithrombotics offers a viable management strategy for STEMI with large thrombus.
Why the study?
Immediate management strategies for large intracoronary thrombus with TIMI 3 flow in STEMI and the risks and benefits of stenting an unobstructed artery remain challenging.
Answers are grounded in this paper and cite their sources.
This case highlights 2 important issues: the immediate management of large intracoronary thrombus in the ST-segment elevation myocardial infarction setting with TIMI 3 flow, and the risks/benefits associated with sealing a plaque in an unobstructed artery by stenting. Potent antithrombotic therapy with a view to subsequent intracoronary imaging to define etiology and plaque morphology appears to be a reasonable initial strategy in this specific population. Furthermore, for patients with acute coronary syndromes diagnosed with plaque erosion by optical coherence tomography and residual diameter stenosis <70%, deferred stenting appears a viable option.
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Theodoropoulos et al. (2022) conducted a review in ST-segment elevation myocardial infarction with large intracoronary thrombus. Potent antithrombotic therapy, intracoronary imaging, and deferred stenting was evaluated. Potent antithrombotic therapy followed by intracoronary imaging and deferred stenting is a viable strategy for managing large intracoronary thrombus in STEMI patients with TIMI 3 flow.
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