Lots of interesting abstracts and cases were submitted for TCTAP 2025. 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-026
Dealing With Thrombus in Primary PCI
By Purushottam Kumar
Presenter
Purushottam Kumar
Authors
Purushottam Kumar1
Affiliation
Popular Heart Clinic, India1,
View Study Report
TCTAP C-026
Coronary - ACS/AMI
Dealing With Thrombus in Primary PCI
Purushottam Kumar1
Popular Heart Clinic, India1,
Clinical Information
Patient initials or Identifier Number
Relevant Clinical History and Physical Exam
56 YEARS OLD GENTLEMAN PRESENTED TO OPD WITH ONGOING CHEST PAIN WHICH WASRETROSTERNAL AND RADIATED TO LEFT ARM AND DURATION OF PAIN IS 4 HOURS .
HE HAD 1EPISODE OF VOMITING
HE IS A NON HYPERTENSIVE NON DIABETIC INDIVIDUAL
Relevant Test Results Prior to Catheterization
BLOOD PRESSURE WAS 96/54 MM HG AND PULSE RATE OF 64 BPM
ECHOCARDIOGRAPHY SHOWED INFERIOR WALL HYPOKINESIA (A+M+B) WITH A LVEF 45% AND TAPSE OF 16
CBC SHOWED HB OF 12.4 G/DL,CREATININE 1.2 G/DL,VIRAL MARKERS WHERE NEGATIVE
Relevant Catheterization Findings
FEMORAL ROUTE WAS SELECTED IN THE CASE6 FR SHEATH WAS PLACED WITH ALL PRECAUTIONS AND 6 FR JUDKINS GUIDE CATHETER WAS USEDRCA WAS ENGAGAED RCA -100% CUT OFF LAD,LCX-NORMALWITH GREAT DIFFICULTY WISPER WIRE WITH BALLOON SUPPORT OF 1.2 MM X 8 NC TRAVELER WAS PASSEDTHROMBOSUCTION WAS DONE AND VERY HAZY TIMI I FLOW WAS ACHIEVED AND TIMI GRADE 3 THROMBUS WAS OBSERVEDA FRESH RED THROMBUS WAS EXTRACTED DEFERRED STENTING WAS DONE AND TIMI III FLOW ACHIEVED LATER
Interventional Management
Procedural Step
DEFERRED STENTING TECHNIQUE WAS USED CONSIDERING HIGH THROMBUS BURDEN AND RISK OF NO FLOW SLOW FLOW.TIMI I FLOW WAS ACHIEVED WITH HELP OF THROMBOSUCTION ;INTRCORONARY LYTICS WHERE DEFERRED CONSIDERING RISK OF BLEEDING HAEMORRHOIDS WHICH PATIENT FREQUENTLY COMPLAINED..DEFERRED STENTING HAS RISK OF NO FLOW SLOW FLOW BUT REDUCES THROMBUS BURDENNEXT DAY JUDKINS RIGHT GUIDE CATHETER WAS USED AND SION BLUE WIRE COULD BE PASSED AND 2 STENTS 2.5 X 28 MM DISTALLY AND 3.0 X 16 MM PROXIMALLY WAS PLACED AND TIMI III FLOW WAS ACHIEVED
Case Summary
Patients with ST-elevation MI (STEMI) usually have a huge thrombus burden in the infarct-related artery. Stenting may lead to high chances of the slow-flow/no-reflow phenomenon that leads to periprocedural MI and adverse cardiovascular events. Deferred stenting may be beneficial in this situation as the thrombus burden will reduce, mitigating the slow-flow/no-reflow phenomenon. However, routine deferral of stenting in patients with STEMI has not been found to be beneficial, but when the patient is properly selected, deferred stenting has the potential for reducing the final infarct size