Thrombolysis-Guided Primary Percutaneous Coronary Intervention

Area of Science:

• Cardiology
• Interventional Cardiology
• Emergency Medicine

Background:

• ST-elevation myocardial infarction (STEMI) is a critical condition requiring timely reperfusion.
• Percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for STEMI.
• Complex PCI cases can present significant technical challenges.

Observation:

• A 77-year-old STEMI patient experienced hemodynamic instability during attempted PCI.
• Operators could not visualize the right coronary artery ostium despite multiple attempts.
• Systemic thrombolysis was administered to address the complications.

Findings:

• Systemic thrombolysis successfully resolved the hemodynamic instability and facilitated visualization of the coronary artery ostium.
• PCI was subsequently able to proceed after thrombolysis.
• This case underscores the potential utility of fibrinolysis in specific complex PCI scenarios.

Implications:

• Fibrinolysis remains a valuable therapeutic option for select STEMI patients facing procedural difficulties during PCI.
• This case highlights the importance of considering fibrinolysis as a rescue therapy in interventional cardiology.
• Integrating fibrinolysis into modern PCI algorithms may improve outcomes in challenging myocardial infarction cases.