Deferring stent optimization in stent thrombosis: A novel approach for STEMI management-Insights from a case series

Giacomo Maria Cioffi, Mehdi Madanchi, Matthias Bossard, Florim Cuculi, Giacomo Maria Cioffi, Mehdi Madanchi, Matthias Bossard, Florim Cuculi

Abstract

Treatment of ST represents a challenge. The presence of large amounts of thrombus combined with stent optimization increase the risk of distal embolization. A two-step strategy of stent implantation and deferred stent optimization might be appropriated. We hereby present three clinical cases of ST successfully treated with a two-step approach.

Keywords: PCI; STEMI; distal embolization; microvascular obstruction; optical coherence tomography; stent thrombosis.

Conflict of interest statement

GM Cioffi and M Madanchi report no conflicts of interest. M. Bossard has received consulting and speaker fees from Amgen, Astra Zeneca, Bayer, and Mundipharma. F Cuculi has received consulting and speaker fees from SIS Medical and Abbott Vascular.

© 2021 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Angiography Images. A, B, PCI and DES to the proximal right coronary artery (RCA) for an AMI 5 years earlier. C, Predilatation and thrombectomy not able to completely restore flow (TIMI 1). D, Implantation of a DES at nominal pressure immediately restored TIMI 3 flow. E, F, Postdilatation with a NC balloon corrected stent under‐expansion and improved stent apposition
FIGURE 2
FIGURE 2
OCT Images. A, Presence of large amount of white and red thrombus, excessive neointima formation and a previously implanted and under‐expanded stent. B, 5 days later, OCT‐guided stent optimization showed residual thrombus, under‐expansion, and malapposition of the newly implanted stent. C, Aggressive postdilatation with NC balloon corrected stent under‐expansion and improved stent apposition

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Source: PubMed

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