PCI in the Patient with Angiographically Visible Thrombus: Difference between revisions
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Revision as of 11:15, 25 October 2011
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The presence of angiographically apparent thrombosis associated with adverse outcomes during the performance of PCI.
Treatment
Glycoprotein 2b3a inhibition
Glycoprotein 2b3a inhibition is effective in those patients who are troponin positive, and there is a consensus that they are useful in those patients with angiographically visible clot.
Thrombus Aspiration
In the setting of ST segment elevation MI, mechanical aspiration of thrombus has been associated with improved myocardial perfusion and improve survival.
Direct Stenting
It has been speculated that the direct stenting minimizes distal embolization. This approach has been associated with reduced risk of myonecrosis in meta-analyses.
Intracoronary Fibrinolytic Therapy
For those clots that are resistant to thrombus aspiration, intracoronary fibrinolytic therapy is a consideration. Doses of up to 20 mg of tPA administered at a dose of 2 mg at a time are conventionally used.
Distal Protection
Distal protection has been associated with a reduced risk of myonecrosis, particularly in saphenous vein graft lesions. It's utility native coronary arteries is not well demonstrated.