Optical coherence tomography, delayed stent implantation and primary percutaneous coronary intervention in patients with myocardial infarction and ST segment elevation

Czech version

Authors: Pavel Červinka ^1,2,3
Authors‘ workplace: I. interní kardioangiologická klinika LF UK a FN Hradec Králové, přednosta prof. MUDr. Pavel Červinka, Ph. D. ¹; Kardiologická klinika Masarykovy nemocnice v Ústí nad Labem, Krajská zdravotní, a. s., přednosta prof. MUDr. Pavel Červinka, Ph. D. ²; Fakulta zdravotnických studií UJEP Ústí nad Labem, děkan doc. MUDr. Miroslav Tichý, CSc. ³
Published in: Vnitř Lék 2014; 60(4): 293-297
Category: 60th Birthday - prof. MUDr. Petr Widimský, DrSc., FESC, FACC

Overview

Primary percutaneous coronary intervention (PCI) is an effective treatment for myocardial infarction with ST-segment elevation. However, the stent may slow (slow-flow) or even interrupt the flow (no-reflow) in the infarct-related artery with an increase in short-term and long-term mortality. Due to these limitations there is an effort to search for alternative methods or certain modifications of existing PCI. Present article introduces a modified PCI and results of trombo-aspiration technique by optical coherence tomography (OCT). The article presents the results of our clinical study and brief case report. Our pilot project involved 100 patients with STEMI in 2011–2012. 20 patients (20%) were initially treated only with trombo-aspiration without stent implantation, based on OCT. Control angiography and OCT done 9 months after event have revealed insignificant stenosis in all patients. It is plausible that universal medical procedure with stenting is not suitable for all patients with STEMI and especially patients with large thrombus may benefit from the alternative procedure performed by manually trombo-aspiration technique with intensive anticoagulant/antiaggregant therapy. Nevertheless, only randomized trials with sufficiently follow-up may confirm this hypothesis.

Key words:
delayed stent implantation – optical coherence tomography – primary percutaneous coronary intervention – trombo-aspiration

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