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Direct stenting in angiographically apparent thrombus-containing lesions
T Timurkaynak1, M Ozdemir, A Cengel
1Gazi University Medical School, Department of Cardiology, Besevler, 06500, Ankara, Turkey. ttimurkaynak@superonline.com
Insights
Direct stenting is a safe and effective method for treating thrombus-containing lesions, significantly reducing the risk of no-reflow and improving blood flow. This approach shows promise in interventional cardiology.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Acute Coronary Syndromes
Background:
- Limited data exists on the benefits of direct stenting for lesions with visible thrombus.
- Thrombus-containing lesions pose challenges in percutaneous coronary intervention.
- Evaluating direct stenting's impact on angiographic outcomes in these complex cases is crucial.
Purpose of the Study:
- To assess the efficacy and safety of a direct stenting strategy in patients with thrombus-containing coronary lesions.
- To evaluate the impact on angiographic results, specifically TIMI (Thrombolysis in Myocardial Infarction) flow.
- To determine the incidence of complications such as no-reflow.
Main Methods:
- Retrospective review of an institutional interventional database.
- Inclusion of 30 patients with angiographically apparent thrombus-containing lesions.
- Analysis of baseline characteristics, procedural success, and post-procedural outcomes, including TIMI flow and complications.
Main Results:
- Successful stent implantation in all patients without crossing failure or stent loss.
- A high final TIMI 3 flow rate (93%) was achieved, with no instances of no-reflow.
- Low rates of in-hospital adverse events, including no deaths or repeat interventions; 6.6% experienced recurrent myocardial infarction.
Conclusions:
- Direct stenting appears to be a safe and feasible strategy for managing thrombus-containing coronary lesions.
- This approach effectively prevents no-reflow and achieves favorable angiographic outcomes.
- Further randomized studies are warranted to compare direct stenting with conventional stenting in this patient population.
Abstract:
The data regarding the potential benefits of direct stenting in the setting of angiographically apparent thrombus-containing lesions are scarce. The aim of this study was to evaluate the impact of direct stenting on the angiographic results in the setting of thrombus. We reviewed our institutional interventional database and identified 30 patients who had undergone stenting in the setting of angiographically apparent thrombus-containing lesions (33% unstable angina pectoris, 67% acute myocardial infarction). The majority of patients had a baseline TIMI 2 and 3 flow (80%). Of the 6 patients (20%) who had TIMI 0-1 flow at baseline, four of them achieved a TIMI 2 flow immediately after crossing the lesion with a 0.014 guidewire. Although the remaining 2 patients had TIMI 1 flow, as distal opacification beyond the stenosis was obtained we successfully implanted the stents directly. All stents were successfully implanted without any crossing failure or stent loss. There was no "no re-flow", with a final TIMI 3 flow rate in 93%. In 1 patient with TIMI 2 flow after stenting, TIMI 3 flow was obtained after intracoronary verapamil. In 2 patients (7%, TIMI 2 flow), a final TIMI 3 flow could not be achieved despite intracoronary nitroglycerin and verapamil. There was no stent loss and imprecise stent placement. There were no in-hospital deaths, repeat interventions or coronary artery bypass graft surgeries. However, two patients had undergone mitral valve replacement due to severe mitral regurgitation. Eight patients with recurrent ischemia had control angiography; stents were found to be patent in all 8 patients. Two patients experienced recurrent myocardial infarction (6.6%). Direct stenting strategy in thrombus-containing lesions seems to be a safe and feasible approach in avoiding no re-flow. We believe that benefits observed with direct stenting in this study should be compared to conventional stenting in the same setting with a randomized study.