Case Report: ST-Elevation Myocardial Infarction Secondary to Acute Atherothrombotic Occlusion Treated With No Stent
Rahul Dhawan1, Saurabhi Samant2, Ganesh Gajanan2
1Cardiovascular Division, Mayo Clinic, Rochester, MN, United States.
Insights
ST-elevation myocardial infarction (STEMI) in a young woman was successfully treated with thrombus aspiration alone, avoiding stent placement. Intravascular imaging guided this approach, preventing potential complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- ST-elevation myocardial infarction (STEMI) necessitates prompt diagnosis and treatment.
- Intravascular imaging is crucial for understanding the pathophysiology of STEMI.
- Plaque erosion is an underrecognized cause of STEMI.
Observation:
- A 43-year-old female presented with anterior STEMI.
- Optical coherence tomography (OCT) revealed plaque erosion as the cause of acute thrombotic occlusion.
- Spontaneous recanalization was observed after initial thrombotic occlusion.
Findings:
- A no-stent strategy using aspiration thrombectomy and dual antiplatelet therapy was effective.
- Intravascular imaging identified plaque erosion, obviating the need for angioplasty and stenting.
- The patient avoided potential stent-related complications like restenosis and thrombosis.
Implications:
- Individualized, pathophysiology-guided treatment can optimize outcomes in acute coronary syndromes.
- Intracoronary imaging can significantly alter management strategies for STEMI.
- Avoiding unnecessary interventions like stenting can prevent long-term complications, particularly in younger patients.
Background:
Intravascular imaging plays a vital role in the pathophysiology-based diagnosis and treatment of patients with ST-elevation myocardial infarction (STEMI). We present a case of STEMI due to plaque erosion, which was managed with a no stent approach.
Case Summary:
A 43-year-old female with a history of tobacco abuse presented with an anterior STEMI. Coronary angiography revealed acute thrombotic occlusion of the left anterior descending artery with spontaneous recanalization. Intravascular imaging with optical coherence tomography (OCT) demonstrated plaque erosion as the underlying etiology for the acute thrombotic occlusion. A no stent strategy with aspiration thrombectomy and dual antiplatelet therapy was used to manage the patient given that there was no evidence of plaque rupture. Repeat coronary imaging was done at 2 months to assess the status of the lesion.
Conclusion:
A 43-year-old female with STEMI due to plaque erosion was successfully managed only by thrombus aspiration and not by angioplasty and stent placement. Individualized treatment approaches in patients with acute coronary syndromes, can not only achieve optimal management goals but also avoid unnecessary complications associated with interventions. This case illustrates how intracoronary imaging and pathophysiology-guided treatment can dramatically change management. In this young patient, STEMI was managed purely by thrombus aspiration. Intravascular imaging obviated the need for stent placement possibly preventing stent-related complications including restenosis and thrombosis.
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