A case of myocardial infarction not to be stented too quickly

This is a case of an interventional dilemma about how to manage a large thrombus, located distally from and adherent to a severe stenosis in a coronary venous bypass graft, with a TIMI-3 flow in a patient with a non-ST-elevation myocardial infarction. This case report concerns a 70-year-old female patient, diagnosed with unstable angina, 18 asymptomatic years after coronary bypass surgery. Although a high risk of a severe ischaemic event is present, immediate coronary intervention is not mandatory since perfusion is maintained, and given the real risk of embolisation of the large thrombus, even contra-indicated. From this perspective, the option to bail out and install an extensive antithrombotic therapy prior to delayed intervention is reasonable.