Subocclusive giant thrombus in the coronary artery: what should be the preferred treatement strategy?

█ Case report

DOI: 10.26430/CHUNGARICA.2022.52.5.363

Authors:
Óvári Péter¹, Veress Gábor¹, Aradi Dániel^1,2
1Állami Szívkórház, Balatonfüred
²Semmelweis Egyetem, Városmajori Szív- és Érgyógyászati Klinika, Budapest

Summary

The most common cause of ST-elevation myocardial infarction (STEMI) is thrombotic coronary occlusion due to plaque rupture. According to the most recent guidelines, primary PCI with implantation of a drug eluting stent is the treatment of choice in case of STEMI. However, there are some special cases, when implantation of a stent is not feasible or the potential complication rate is high. In our case report, we would like to present a special STEMI case, where a subocclusive giant thrombus was verified as a culprit lesion on coronary angiography. The embolic risk of classic PCI was high because of the character of the lesion. Therefore, instead of primary PCI, we initiated a combined antithrombotic strategy followed by serial control angiography and intravascular imaging. The thrombus was fully dissolved in 10 days according to angiography, and intravascular imaging (OCT) did not show any intimal injury requiring stent implantation. In selected STEMI cases where the culprit lesion is highly thrombotic and carries a high embolic risk, intensified combined antithrombotic treatment with serial intravascular imaging may be a feasible option if the flow is preserved and there are no signs of ischemia with favorable clinical outcome.

ISSUE: CARDIOLOGIA HUNGARICA | 2022 | VOLUME 52, ISSUE 5