Management of no Reflow during Percutaneous Transcoronary Angioplasty with Catheter-Directed Intracoronary Thrombolysis: A Retrospective Observational Study.

Pub Date : 2022-10-01 Epub Date: 2022-12-19 DOI:10.4103/ijabmr.ijabmr_407_22

Rakendra Singh, Sanjeev Kumar Singla, Ankush Singla, Surbhi Manchanda, Manjot Kaur

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Abstract

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.

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导管引导冠状动脉内溶栓治疗经皮冠状动脉血管成形术中无回流的回顾性观察研究。

背景：冠状动脉内血栓在ST段抬高型心肌梗死（STEMI）患者中很常见。经皮冠状动脉介入治疗（PCI）是这些患者的首选治疗方法。冠状动脉内血栓在STEMI PCI期间仍然是一个挑战，即使使用双重抗血小板、糖蛋白IIb/IIIa抑制剂和抗凝治疗。冠状动脉内血栓可导致远端或非狭窄血管栓塞，且无回流状态。无再流导致梗死面积大、左心室重构不良、心律失常和死亡。最近，由于血栓负担大，导管引导的冠状动脉内溶栓（ICT）在无回流的患者中越来越被接受。目的：评估导管导向ICT在急性ST段抬高型心肌梗死患者中的作用，这些患者在PCI过程中因大量血栓负担而无复流。材料、方法和结果：这是一项回顾性观察性研究，于2021年4月15日至2022年4月14日在印度北部一家三级护理医院经机构伦理委员会批准后进行，包括1020名接受过冠状动脉评估的成年患者。37.25%的患者进行了PCI，其中10%的患者因急性STEMI进行了PCI。心肌梗死溶栓（TIMI）5级79.17%，4级20.83%。ICT采用低剂量替萘普酶（15±5 mg）。冠状动脉内溶栓后TIMI血流III达到91.67%，II达到8.33%。主要危险因素是吸烟（41.67%），主要并发症是左心室衰竭（33.33%）。这种情况预后严重，可能导致不良的心脏后果。有许多药物已经被尝试来管理无回流。使用ICT治疗无回流状态可以挽救生命，系统副作用最小。

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