Intracoronary thrombolysis and stentless primary percutaneous coronary intervention in an ectatic right coronary

Related Experiment Video

Updated: Nov 26, 2025

Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
05:26

Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction

Published on: May 28, 2019

9.5K

George Kassimis1,2, Petros Faliagkas1, Polykarpos Pshochias2

  • 1Second Cardiology Department, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Future Cardiology
|December 10, 2020
PubMed

Insights

Intracoronary thrombolysis effectively restored blood flow in an ectatic right coronary artery with significant clot burden when thrombectomy failed. This approach offers a safe and effective treatment for ST-segment elevation myocardial infarction patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • ST-segment elevation myocardial infarction (STEMI) requires prompt restoration of coronary blood flow.
  • Ectatic coronary arteries present unique challenges in managing occlusive thrombus.
  • Micro-computed tomography (CT) can quantify thrombus burden in complex coronary anatomy.

Observation:

  • A 58-year-old male presented with inferior STEMI due to a mid-vessel occluded right coronary artery (RCA).
  • The RCA exhibited ectasia and a significant thrombus burden, confirmed by micro-CT.
  • Initial attempts at manual and 'mother-child' thrombectomy were unsuccessful in restoring flow.

Findings:

  • Guide catheter-directed intracoronary thrombolysis using low-dose tenekteplase successfully achieved Thrombolysis In Myocardial Infarction (TIMI) 3 flow in the RCA.
  • A stentless strategy was employed post-thrombolysis, leaving no angiographically significant stenosis.
  • The combined approach proved effective in resolving the occlusion.

Implications:

  • Intracoronary thrombolysis is a viable and effective alternative when mechanical thrombectomy fails in STEMI with ectatic arteries and large thrombus.
  • A stentless strategy can be safely utilized in selected STEMI cases, potentially reducing procedural complications.
  • This case highlights a successful treatment paradigm for complex coronary occlusions in STEMI.

Keywords:
ST-segment elevation myocardial infarctionectatic coronary arteryintracoronary thrombolysislarge thrombus burdenmanual aspirationmicro-computed tomographystentless percutaneous coronary interventionthrombectomy“mother–child”

More Related Videos

Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs14:35

Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs

Published on: April 17, 2021

8.8K
Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control05:41

Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control

Published on: December 16, 2022

4.0K

Related Concept Videos

Coronary Artery Disease V: Interprofessional Care01:27

Coronary Artery Disease V: Interprofessional Care

Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
131
Acute Coronary Syndrome I: Introduction01:30

Acute Coronary Syndrome I: Introduction

Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
347
Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
106
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care01:29

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care

Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
127
Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
97
Peripheral Artery Disease III: Interprofessional Care01:27

Peripheral Artery Disease III: Interprofessional Care

Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
125