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Management of no Reflow during Percutaneous Transcoronary Angioplasty with Catheter-Directed Intracoronary Thrombolysis: A Retrospective Observational Study
BACKGROUND: Intracoronary thrombus is common in patients with ST-elevation myocardial infarction (STEMI). Percutaneous coronary intervention (PCI) is the treatment of choice for these patients. Intracoronary thrombus is still a challenge during PCI in STEMI, even with dual antiplatelets, glycoprotei...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9886142/ https://www.ncbi.nlm.nih.gov/pubmed/36726658 http://dx.doi.org/10.4103/ijabmr.ijabmr_407_22 |
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author | Singh, Rakendra Singla, Sanjeev Kumar Singla, Ankush Manchanda, Surbhi Kaur, Manjot |
author_facet | Singh, Rakendra Singla, Sanjeev Kumar Singla, Ankush Manchanda, Surbhi Kaur, Manjot |
author_sort | Singh, Rakendra |
collection | PubMed |
description | BACKGROUND: Intracoronary thrombus is common in patients with ST-elevation myocardial infarction (STEMI). Percutaneous coronary intervention (PCI) is the treatment of choice for these patients. Intracoronary thrombus is still a challenge during PCI in STEMI, even with dual antiplatelets, glycoprotein IIb/IIIa inhibitor, and anticoagulation. Intracoronary thrombus can cause distal or nonculprit vessel embolization and no-reflow state. No reflow results in large infarct size, adverse left ventricular remodeling, arrhythmias, and death. Recently, catheter-directed intracoronary thrombolysis (ICT) is gaining acceptance in patients with no-reflow due to a large thrombus burden. AIM: Evaluation of catheter-directed ICT in patients with acute STEMI who develop no reflow due to large thrombus burden during PCI. MATERIALS AND METHODS AND RESULTS: This was a retrospective observational study conducted after approval of the institutional ethics committee in a tertiary care hospital of north India from April 15, 2021 to April 14, 2022, included 1020 adult patients who had undergone coronary evaluation. 37.25% patients had PCI, among these 10% had PCI for acute STEMI. Thrombolysis in myocardial infarction (TIMI) Grade 5 in 79.17% and Grade 4 in 20.83%. ICT was done with low-dose tenecteplase (15 ± 5 mg). The TIMI flow III in 91.67% and II in 8.33% of patients was achieved after intracoronary thrombolysis. Major risk factor was tobacco smoking in 41.67%, and the major complication was left ventricular failure in 33.33%. CONCLUSIONS: Catheter-directed ICT is safe and effective in reducing thrombus burden, thus improving myocardial reperfusion in STEMI. This condition has a grave prognosis and can lead to adverse cardiac outcomes. There are many drugs that have been tried to manage no reflow. The use of ICT to treat no-reflow state can be life saving with minimal systemic side effects. |
format | Online Article Text |
id | pubmed-9886142 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-98861422023-01-31 Management of no Reflow during Percutaneous Transcoronary Angioplasty with Catheter-Directed Intracoronary Thrombolysis: A Retrospective Observational Study Singh, Rakendra Singla, Sanjeev Kumar Singla, Ankush Manchanda, Surbhi Kaur, Manjot Int J Appl Basic Med Res Original Article BACKGROUND: Intracoronary thrombus is common in patients with ST-elevation myocardial infarction (STEMI). Percutaneous coronary intervention (PCI) is the treatment of choice for these patients. Intracoronary thrombus is still a challenge during PCI in STEMI, even with dual antiplatelets, glycoprotein IIb/IIIa inhibitor, and anticoagulation. Intracoronary thrombus can cause distal or nonculprit vessel embolization and no-reflow state. No reflow results in large infarct size, adverse left ventricular remodeling, arrhythmias, and death. Recently, catheter-directed intracoronary thrombolysis (ICT) is gaining acceptance in patients with no-reflow due to a large thrombus burden. AIM: Evaluation of catheter-directed ICT in patients with acute STEMI who develop no reflow due to large thrombus burden during PCI. MATERIALS AND METHODS AND RESULTS: This was a retrospective observational study conducted after approval of the institutional ethics committee in a tertiary care hospital of north India from April 15, 2021 to April 14, 2022, included 1020 adult patients who had undergone coronary evaluation. 37.25% patients had PCI, among these 10% had PCI for acute STEMI. Thrombolysis in myocardial infarction (TIMI) Grade 5 in 79.17% and Grade 4 in 20.83%. ICT was done with low-dose tenecteplase (15 ± 5 mg). The TIMI flow III in 91.67% and II in 8.33% of patients was achieved after intracoronary thrombolysis. Major risk factor was tobacco smoking in 41.67%, and the major complication was left ventricular failure in 33.33%. CONCLUSIONS: Catheter-directed ICT is safe and effective in reducing thrombus burden, thus improving myocardial reperfusion in STEMI. This condition has a grave prognosis and can lead to adverse cardiac outcomes. There are many drugs that have been tried to manage no reflow. The use of ICT to treat no-reflow state can be life saving with minimal systemic side effects. Wolters Kluwer - Medknow 2022 2022-12-19 /pmc/articles/PMC9886142/ /pubmed/36726658 http://dx.doi.org/10.4103/ijabmr.ijabmr_407_22 Text en Copyright: © 2022 International Journal of Applied and Basic Medical Research https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Singh, Rakendra Singla, Sanjeev Kumar Singla, Ankush Manchanda, Surbhi Kaur, Manjot Management of no Reflow during Percutaneous Transcoronary Angioplasty with Catheter-Directed Intracoronary Thrombolysis: A Retrospective Observational Study |
title | Management of no Reflow during Percutaneous Transcoronary Angioplasty with Catheter-Directed Intracoronary Thrombolysis: A Retrospective Observational Study |
title_full | Management of no Reflow during Percutaneous Transcoronary Angioplasty with Catheter-Directed Intracoronary Thrombolysis: A Retrospective Observational Study |
title_fullStr | Management of no Reflow during Percutaneous Transcoronary Angioplasty with Catheter-Directed Intracoronary Thrombolysis: A Retrospective Observational Study |
title_full_unstemmed | Management of no Reflow during Percutaneous Transcoronary Angioplasty with Catheter-Directed Intracoronary Thrombolysis: A Retrospective Observational Study |
title_short | Management of no Reflow during Percutaneous Transcoronary Angioplasty with Catheter-Directed Intracoronary Thrombolysis: A Retrospective Observational Study |
title_sort | management of no reflow during percutaneous transcoronary angioplasty with catheter-directed intracoronary thrombolysis: a retrospective observational study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9886142/ https://www.ncbi.nlm.nih.gov/pubmed/36726658 http://dx.doi.org/10.4103/ijabmr.ijabmr_407_22 |
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