Role of Glycoprotein 2B/3A Inhibitors in STEMI with Large Clot Burden and Deferred Stenting

A 62 years old male presented with acute inferior wall ST-elevation myocardial infarction. His coronary angiogram showed totally occluded right coronary artery with large thrombus burden with TIMI-0 flow. Multiple attempts were made to aspirate the clot using mechanical thrombus aspiration catheter, but no thrombus could be aspirated. Guideliner catheter was used to aspirate some thrombus, resulting in final TIMI-I flow. He was treated with 48 hours of Tirofiban Glycoprotein 2b3a inhibitor infusion along with low molecular weight heparin. Re-look coronary angiogram showed TIMI-II flow with less thrombus burden. Eventually, stent was deployed and good flow was achieved without any no flow/ slow flow. As per revascularization guidelines, routine thrombus aspiration and deferral of stenting in patients with STEMI is not recommended. However, this case indicates that if thrombus burden is heavy, aspiration is unsuccessful; it is advised to defer stenting and treat with Glycoprotein 2b3a inhibitors and low molecular weight heparins to prevent complications of no flow or slow flow phenomena. If patient is properly selected, deferred stenting can reduce final infarct size and potential cardiac events.