Management of no Reflow during Percutaneous Transcoronary Angioplasty with Catheter-Directed Intracoronary Thrombolysis: A Retrospective Observational Study

Rakendra Singh; Sanjeev Kumar Singla; Ankush Singla; Surbhi Manchanda; Manjot Kaur

doi:10.4103/ijabmr.ijabmr_407_22

Management of no Reflow during Percutaneous Transcoronary Angioplasty with Catheter-Directed Intracoronary Thrombolysis: A Retrospective Observational Study

Int J Appl Basic Med Res. 2022 Oct-Dec;12(4):260-264. doi: 10.4103/ijabmr.ijabmr_407_22. Epub 2022 Dec 19.

Authors

Rakendra Singh¹, Sanjeev Kumar Singla², Ankush Singla², Surbhi Manchanda¹, Manjot Kaur³

Affiliations

¹ Department of Medicine, Adesh Institute of Medical Sciences and Research Bhatinda, Punjab, India.
² Department of Anaesthesiology and Intensive Care, Adesh Institute of Medical Sciences and Research Bhatinda, Punjab, India.
³ Department of Radiology, Adesh Institute of Medical Sciences and Research Bhatinda, Punjab, India.

Abstract

Background: Intracoronary thrombus is common in patients with ST-elevation myocardial infarction (STEMI). Percutaneous coronary intervention (PCI) is the treatment of choice for these patients. Intracoronary thrombus is still a challenge during PCI in STEMI, even with dual antiplatelets, glycoprotein IIb/IIIa inhibitor, and anticoagulation. Intracoronary thrombus can cause distal or nonculprit vessel embolization and no-reflow state. No reflow results in large infarct size, adverse left ventricular remodeling, arrhythmias, and death. Recently, catheter-directed intracoronary thrombolysis (ICT) is gaining acceptance in patients with no-reflow due to a large thrombus burden.

Aim: Evaluation of catheter-directed ICT in patients with acute STEMI who develop no reflow due to large thrombus burden during PCI.

Materials and methods and results: This was a retrospective observational study conducted after approval of the institutional ethics committee in a tertiary care hospital of north India from April 15, 2021 to April 14, 2022, included 1020 adult patients who had undergone coronary evaluation. 37.25% patients had PCI, among these 10% had PCI for acute STEMI. Thrombolysis in myocardial infarction (TIMI) Grade 5 in 79.17% and Grade 4 in 20.83%. ICT was done with low-dose tenecteplase (15 ± 5 mg). The TIMI flow III in 91.67% and II in 8.33% of patients was achieved after intracoronary thrombolysis. Major risk factor was tobacco smoking in 41.67%, and the major complication was left ventricular failure in 33.33%.

Conclusions: Catheter-directed ICT is safe and effective in reducing thrombus burden, thus improving myocardial reperfusion in STEMI. This condition has a grave prognosis and can lead to adverse cardiac outcomes. There are many drugs that have been tried to manage no reflow. The use of ICT to treat no-reflow state can be life saving with minimal systemic side effects.

Keywords: Intracoronary thrombolysis; ST-elevation myocardial infarction; no reflow; percutaneous coronary intervention.