Reasi, September 28, 2022
Middle age man hailing from Jammu with no comorbid conditions presented to SMVDNSH emergency room with Acute ST Elevation Myocardial Infarction. On evaluation with ECG found to have Acute Inferior Wall MI. He was taken to cath lab immediately and Coronary Angiography was done which showed proximal Right Coronary artery 100% massive thrombotic occlusion. Routine Angioplasty was tried and we were able to put a wire into the Right coronary artery. Multiple attempts to open the thrombotic artery using multiple balloons inflations & manual aspiration thrombectomy devices was tried but to no respite, failed to open the infarct related artery. To salvage and save the heart muscles (myocardium), catheter directed intra coronary thrombolytic drug (ALTEPLASE) was given directly into the distal part of the artery. Patient was then shifted to Coronary Care Unit for observation. After 24 hrs, check CAG done showed recovery/restoration of blood flow into right coronary artery with little chunk of thrombus lying proximally for which stent was placed successfully. Patient got discharged on Day 2 after procedure and is doing well & on routine follow up. Stating further about the case Dr. Sushant Kumar Sharma, DM CARDIOLOGY and Senior Interventional Cardiologist at Narayana Hospital said that large thrombus burden can negatively impact the outcomes following Primary Angioplasties such as distal embolization of clot, no flow or slow flow in the Coronary artery, increase in infarct size, stent thrombosis and even death in patient with Acute MI. Catheter directed intra coronary thrombolysis can be performed effectively & safely when repeated balloon inflations andi Manual Aspiration Thrombectomy (MAT) fails to produce satisfactory coronary reperfusion (blood flow) in STEMI patients with large thrombus burdens.
