Best Practices in Cath Lab Management for STEMI Enduring-Case of STEMI With Large Thrombus Burden

Video Transcription

Video Summary

The transcript recounts the case of a 59-year-old man with a large thrombus burden in STEMI, who initially presented with two months of chest pressure and NSTEMI. Angiograms revealed significant thrombus in the right coronary artery and robust collateral circulation from the left side. Initial treatment involved a semi-compliant balloon and manual thrombectomy, which did not retrieve a clot, leading to deferred stenting. The patient, stable due to collateral flow, was placed on dual antiplatelet therapy. Upon return for stenting, large diameter stents were placed successfully, but residual distal thrombus was noted. Following this, the patient experienced a VF arrest and recurrent STEMI, requiring repeated intervention and thrombectomy. Key discussion points included the challenges of guide selection, techniques for thrombectomy, intracoronary imaging, and the application of clinical guidelines to manage such cases. The document underscores the complexity of decision-making in the cath lab, emphasizing the utility of intracoronary imaging and collaborative review in treatment planning.

Asset Subtitle

Celina Yong, MD, MBA, MSc, FSCAI

Keywords

STEMI

thrombectomy

intracoronary imaging

dual antiplatelet therapy

VF arrest