Stent thrombosis of LAD ostial stents

Stent thrombosis is nightmare for all cardiologists as it has high mortality. Current belief of treatment for stent thrombosis is PCI. For this we need 24 hour running lab which may not be feasible in most centers.

For patient who present with stent thrombosis especially in LAD ostial.  I personally felt that it is better to give fibrinolytics rather than take them for Intervention.

There are few reports across net where successfully patient have been managed with lysis with good results.
In LAD ostial lesion most fearing thing is clots migration to LCX or to LMCA which can be catastrophe.
If one has documented stent thrombosis in LAD ostial lesion by CAG and if presentation following chest is short then I think it is wiser to give intra coronary fibrinolytics may be along with partial obstructed balloon in LCX so drug goes to LAD and act better, I have not tried this because I have fear that patient may collapse if one tries obstruct LCX in this situation so LCX balloon may be occluded intermittently watching hemodynamics.

If one is afraid of occluding LCX just give intra coronary fibrinolytics and check results later may be after half to one hour if the vessel has opened then leave it alone if not then try to open with intervention.

By giving intracoronary fibrinolytics clot may migrate further distally due thrombus punch thus may reduce myocardium area at risk.

If patient is hemodynamically not tolerating then it is better to intervene urgently rather than to wait for fibrinolytics to act.

If cathlab facility is not there then one can give systemic thrombolysis.

Author: Dr Umesh Bilagi

MBBS, MD, DM (cardiology). I am Interventional cardiologist. Blogging is my passion. Associate professor of cardiology KIMS Hubli. Director and consultant at Tatwadarsha Hospital Hubli. Owner of Jeevan Jyoti Hospital Hubli. Mobile +91 9343403620.

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