Management of the thrombotic lesion

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editors-In-Chief:

Goals of Treatment

There are several main goals in treating thrombotic lesions, including:

  • Reperfusion of the epicardial artery and the downstream microvasculature
  • Resolution/reduction of thrombus burden
  • Avoid/minimize distal embolization
  • Avoid/reduce thrombotic major adverse cardiac events (death, MI, recurrent ischemia, urgent target vessel revascularization (TVR))

Treatment Choices

Pharmacologic Therapy

Mechanical Therapy

  • Aspiration Catheter: (Export, Pronto) is the choice prior to the other interventions listed below
  • Percutaneous Coronary Intervention (PCI): Bare metal or drug-eluting stent particularly direct stenting without pre-dilation by conventional balloon angioplasty
  • Distal Protection: (Percusurge guardwire, Triactive, Spider wire, Proxis) particularly in saphenous vein grafts
  • Transluminal Extraction Catheter (TEC)
  • Rheolytic Thrombectomy (Possis Angiojet)

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