Deferred Stenting for Heavy Thrombus Burden During Percutaneous Coronary Intervention for ST-Elevation MI

Akshyaya Pradhan, Monika Bhandari, Pravesh Vishwakarma, Rishi Sethi, Akshyaya Pradhan, Monika Bhandari, Pravesh Vishwakarma, Rishi Sethi

Abstract

Patients with ST-elevation MI (STEMI) usually have a huge thrombus burden in the infarct-related artery. Stenting may lead to high chances of the slow-flow/no-reflow phenomenon that leads to periprocedural MI and adverse cardiovascular events. Deferred stenting may be beneficial in this situation as the thrombus burden will reduce, mitigating the slow-flow/no-reflow phenomenon. However, routine deferral of stenting in patients with STEMI has not been found to be beneficial, but when the patient is properly selected, deferred stenting has the potential for reducing the final infarct size. The authors report the safety and feasibility of deferred stenting after 5 days of prolonged anticoagulation in a 45-year-old smoker with STEMI who had a large thrombus load shown on an angiogram. They review the registries, trials and meta-analyses on deferred stenting in the literature and analyse the benefits and harms of the strategy. They also propose an algorithm for applying a strategy for deferred stenting in clinical practice based on the available data.

Keywords: ST-elevation MI; Slow flow; anticoagulant; deferred stenting; heparin; no reflow; periprocedural MI.

Conflict of interest statement

Disclosure: The authors have no conflicts of interest to declare.

Copyright © 2021, Radcliffe Cardiology.

Figures

Figure 1:. Comparison of Thrombus Burden in…
Figure 1:. Comparison of Thrombus Burden in the First and Deferred Coronary Angiograms of the Patient
Figure 2:. Potential Advantage and Pitfalls of…
Figure 2:. Potential Advantage and Pitfalls of a Deferred Stenting Strategy Compared to Immediate Stenting in Patients with High Thrombus Burden
Figure 3:. Non-uniform Time Intervals Between Index…
Figure 3:. Non-uniform Time Intervals Between Index and Deferred Angiograms Across Various Randomised and Non-randomised Studies
Figure 4:. Suggested Algorithm Regarding Optimal Use…
Figure 4:. Suggested Algorithm Regarding Optimal Use of a Deferred Strategy During Percutaneous Coronary Intervention of STEMI

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