Lots of interesting abstracts and cases were submitted for TCTAP 2023. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!
TCTAP C-032
Double Trouble of High Burden Thrombus and Coronary Aneurysms: A Case Report of Successful Deferred Stenting With Limited Equipment
By Yusra Pintaningrum, Hendy Bhaskara Perdana Putra
Presenter
Yusra Pintaningrum
Authors
Yusra Pintaningrum1, Hendy Bhaskara Perdana Putra2
Affiliation
Mataram University, Indonesia1, Dr. Ramelan Navy Hospital Surabaya, Indonesia2,
View Study Report
TCTAP C-032
CORONARY - Acute Coronary Syndromes (STEMI, NSTE-ACS)
Double Trouble of High Burden Thrombus and Coronary Aneurysms: A Case Report of Successful Deferred Stenting With Limited Equipment
Yusra Pintaningrum1, Hendy Bhaskara Perdana Putra2
Mataram University, Indonesia1, Dr. Ramelan Navy Hospital Surabaya, Indonesia2,
Clinical Information
Patient initials or Identifier Number
Mr. M
Relevant Clinical History and Physical Exam
A 66 years old male presented in the emergency room with typical chest pain and diaphoresis for an hour followed by nausea and vomiting.
He is a heavy smoker with unremarkable previous medical disease.
Initial blood pressure and heart rate were 80/60 mmHg and 42 bpm.
Both of the lung were clear. Neither murmur nor gallop was heard.
He was diagnosed as STEMI inferior with bradycardia and hypotension.
Relevant Test Results Prior to Catheterization
ECG showed ST elevation in II, III, aVF with reciprocal ST depression in aVL and V1 – V3.
White Blood Cell was 13.200/mm3 and troponin was positive.
He was given aspirin 320 mg, clopidogrel 600 mg, atorvastatin 40 mg, and dopamine 5 μg/kg/mnt.
Relevant Catheterization Findings
Angiography found aneurysmal dilatation of RCA with high burden thrombus (TIMI thrombus grade IV)
Interventional Management
Procedural Step
Primary PCI was performed.
Huge thrombus and aneurysms in RCA were found.Unfortunately, GP IIb/IIIa inhibitors and long stents were unavailable in our hospital.
POBA inflation, immediate stenting, and intracoronary fibrinolytic were not considered to tackle this huge thrombus.
Thrombus aspiration was performed. Unfortunately, after 3rd attempt of thrombus aspiration, a no-reflow phenomenon has occurred.
Finally, 2.5mm x 15mm balloons were used to push the thrombus to the distal RCA. TIMI 3 flow was successfully reached.
Due to high burden thrombus and big aneurysm, we consider to did not place any stent in this patient.
Enoxaparin 0,6 cc bid was added for three days.On the 3rd day of hospitalization, chest pain was reduced, ST elevation was decreased, blood pressure was normalized, and the patient was ready to discharge.
Case Summary
Despite immediate stenting being recommended in the last STEMI guideline. However, in several conditions deferred stenting might have a beneficial effect. Low systolic blood pressure, thrombus grade, and lesion length were known to increase the incidence of a no-reflow phenomenon. Additionally, in some cases, intracoronary adrenalin may be given to manage the no-reflow phenomenon.