CONCLUSIONS
Our case series suggests that applying a two-step approach (Central Illustration) in patients with STEMI due to ST is safe and effective. After mechanical recanalization with small balloons and/or manual thrombectomy, we advocate the implantation of an appropriately sized stent at nominal pressure strictly avoiding post-dilatation. In the three cases presented, stent implantation immediately restored TIMI 3 flow and the procedure could be finished quickly. We did not observe any flow deterioration (slow-flow or no-reflow) secondary to distal embolization. When bringing the patients back for stent optimization, usually 3-5 days later, we used OCT to elaborate the mechanism of ST, assess vessel size and check for geographic miss. Use of aggressive balloon dilatation was well tolerated at this point in time and did not cause slow-flow or even no-reflow. Whether this strategy would be a valid approach in larger cohort of patients with STEMI remains to be seen. However, we believe that provisional stent implantation to push thrombus aside and re-establish flow (and optimize 3-5 days later) in ST might reflect a promising and safe approach for patients with STEMI presentation and large thrombus burden.