INTRODUCTION
Nowadays, stent thrombosis (ST) represents a rare but still devastating outcome after percutaneous coronary intervention (PCI) with contemporary stent platforms. The majority of patients present with acute myocardial infarction (AMI), mostly ST-segment elevation myocardial infarction (STEMI), due to thrombotic occlusion of the previously implanted stent. [1, 2]
Two issues may make the treatment of ST challenging. First, intravascular imaging (especially optical coherence tomography, OCT) is key to understand the mechanism of ST (differentiation between mechanical and pharmacological factors), but due to the presence of large amounts of thrombus image interpretation is often hampered. Second, in order to correct mechanical factors, particularly under-expansion, the use of appropriately sized balloons (often at high pressure) is necessary, which in turn increases the risk for distal embolization and flow deterioration, thus increasing myocardial infarction size.
In this context, we present three cases of STEMI patients with ST whom we treated with a novel approach aiming to mitigate the risk for distal embolization. Given the large thrombus burden in ST, we therefore followed a two-step strategy of stent implantation and deferred stent optimization using intravascular imaging.