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Management of no Reflow during Percutaneous Transcoronary Angioplasty with Catheter-Directed Intracoronary

Rakendra Singh1, Sanjeev Kumar Singla2, Ankush Singla2

  • 1Department of Medicine, Adesh Institute of Medical Sciences and Research Bhatinda, Punjab, India.

International Journal of Applied & Basic Medical Research
|February 2, 2023
PubMed

Insights

Catheter-directed intracoronary thrombolysis (ICT) effectively reduces thrombus burden in ST-elevation myocardial infarction (STEMI) patients experiencing no-reflow. This life-saving treatment improves myocardial reperfusion with minimal side effects.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Coronary Syndromes

Background:

  • Intracoronary thrombus is a frequent complication in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI).
  • Large thrombus burden can lead to embolization and a no-reflow state, increasing infarct size and mortality.
  • Catheter-directed intracoronary thrombolysis (ICT) is emerging as a strategy for managing no-reflow due to significant thrombus.

Purpose of the Study:

  • To evaluate the efficacy and safety of catheter-directed ICT in STEMI patients with no-reflow.
  • To assess the impact of ICT on thrombus burden and myocardial reperfusion.

Main Methods:

  • Retrospective observational study of 1020 adult patients.
  • Focus on 10% of patients with acute STEMI undergoing PCI with no-reflow.
  • ICT administered using low-dose tenecteplase (15 ± 5 mg).

Main Results:

  • Thrombolysis in Myocardial Infarction (TIMI) flow Grade 5 in 79.17% and Grade 4 in 20.83% prior to ICT.
  • TIMI flow Grade III achieved in 91.67% and Grade II in 8.33% post-ICT.
  • Major risk factor: tobacco smoking (41.67%). Major complication: left ventricular failure (33.33%).

Conclusions:

  • Catheter-directed ICT is a safe and effective treatment for reducing thrombus burden in STEMI.
  • ICT improves myocardial reperfusion and can be life-saving in no-reflow states.
  • This intervention offers a valuable option with minimal systemic side effects for managing complex STEMI cases.
Abstract

Keywords:
Intracoronary thrombolysisST-elevation myocardial infarctionno reflowpercutaneous coronary intervention

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