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.