eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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2/2023
vol. 19
 
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abstract:
Original paper

Double protection in patients with a massive thrombus in the infarct-related artery – a single-center retrospective study

Piotr Chodór
1
,
Grzegorz Honisz
1
,
Krzysztof Wilczek
2
,
Marcin Świerad
1
,
Karolina Chodór-Rozwadowska
3
,
Zbigniew Kalarus
1

  1. Silesian Center for Heart Diseases, Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Zabrze, Poland
  2. Silesian Center for Heart Diseases, 3rd Department of Cardiology, Medical University of Silesia, Zabrze, Poland
  3. Doctoral School, Division of Medical Sciences in Zabrze, Medical University of Silesia, Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
Adv Interv Cardiol 2023; 19, 2 (72): 127–134
DOI: https://doi.org/10.5114/aic.2023.129211
Online publish date: 2023/06/30
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Introduction:
ST-segment elevation myocardial infarction (STEMI) is associated with thrombus formation on a ruptured or ulcerated atherosclerotic plaque. The consequences of a massive thrombus (MT) may include lack of reperfusion, extensive myocardial infarction (MI) and its complications. Although there are various treatment options for patients with coronary thrombi, double protection (DP) – manual thrombectomy (MTH) with a distal protection device (DPD) – has not been tested yet.

Aim:
To present DP outcomes in the treatment of patients with STEMI and MT patients.

Material and methods:
Fourteen patients with STEMI and MT were included in the study. Those patients underwent primary percutaneous coronary intervention (PPCI) with DP.

Results:
Inferior MI was found in 12 (85.8%) patients. Stents were implanted in 13 (92.8%) patients. Thrombolysis In Myocardial Infarction (TIMI) Thrombus Grade 5 was present in 11 (78.6%) patients and Grade 4 in 3 (21.4%) patients. The median thrombus length was 39.1 mm. Complete reperfusion (TIMI flow 3) was observed in 11 (78.6%) patients and TIMI flow 2 in 3 (21.4%) patients. Myocardial Blush Grade (MBG) was used in patients with TIMI flow 3 and Grade 3 was found in 5 (35.7%) patients. Resolution in ST-segment elevation > 50% was obtained in 13 (92.8%) patients. No myocardial rupture, stroke, or death occurred during hospitalization.

Conclusions:
DP in MT patients is a safe and feasible procedure. However, further observations and studies are needed to assess the efficacy of this method.

keywords:

ST-segment elevation myocardial infarction, primary percutaneous coronary intervention, manual thrombectomy, distal protection device, massive thrombus
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