CASE20210816_001

Case Series Reporting the Role of Direct or Direct like Stenting in Patients with STEMI with High Grade Thrombus

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Presenter

Rohit Mody

Authors

1

Affiliation

, India1
High-Risk Intervention (diabetes, heart failure, renal failure, shock, etc) - High-Risk Intervention

Case Series Reporting the Role of Direct or Direct like Stenting in Patients with STEMI with High Grade Thrombus

1

, India1

Clinical Information

Patient initials or Identifier Number

Case1- 184816 Case2- 184162 Case3- 193677 Case4-193305

Relevant Clinical History and Physical Exam

Case1- 55 years old Acute Anterior wall MI, ischemia time since 6hrs., window period 45mins. Case2-70 years old, Acute Anterior wall MI, Ischemic time 12hrs. Window period 60mins, Case3-65 years old, Acute Inferior wall MI, ischemia time 36 hrs 12hrs stuttering MI, window period 30 mins. Case4- 60 years old, Acute Anterior wall MI, Ischemia Time 20hrs & window period 60 mins 

Relevant Test Results Prior to Catheterization

Case 1- ST elevation on ECG, ECHO showed RWMA in LAD territoryCase 2- ST elevation on ECG, ECHO showed RWMA in LAD territoryCase 3- ST elevation on ECG, ECHO showed RWMA in RCA territoryCase 4-ST elevation on ECG, Patient had primary VT which was Cardioverted, ECHO showed RWMA in LAD territory

Relevant Catheterization Findings

Case1- SVD, LAD 100% with Clot grade 6 Case2-SVD, LAD 99% TIMI 1 flow with Clot grade 4 Case3- SVD, RCA 100% with Clot grade 6 Case4-SVD, LAD100% with Clot grade 6



Interventional Management

Procedural Step

Case1-Crossed with wire & direct stenting done, TIMI 3 flow achieved & MBG of 2 Case2-Crossed with wire & direct stenting done, TIMI 3 flow achieved & MBG of 3 Case3-Crossed with wire & direct stenting done, TIMI 3 flow achieved & MBG of 3 Case4-Crossed with wire & tried to cross with stent, stent not crossing hence pre dilated with 1.25X10 mm Balloon so that stent crosses and distal landing zone is just visible, Post dilatation LAD looked Calcified and distal vessel shows clot burden till end, Direct-Like stenting done after pre-dilation- distally 2.5X44mm at 12 ATM& 3.0X44mm proximally at 18ATM, Initially TIMI 1 flow but eventually with Vasodilators TIMI 3 flow and MBG1

Case Summary

In most of the patients direct stenting is possible.In patients whom stent do not cross or distal vessel after clot not visible, a pre dilatation with very small balloon like 1.25mm balloon can result in direct like stenting.With Direct and Direct-Like stenting success can be reached in almost 100% of the cases.And Direct or Direct-Like stenting simplifies the procedure with less contrast use and almost nil on table complications.However larger studies and randomized trials with follow-up for longer periods are required. However our use of direct or direct-like stenting is a therapy in acute MI which should be used as a default therapy.