Efficacy of intracoronary Streptokinase during primary percutaneous coronary intervention in patients presenting with acute anterior STEMI with a definite thrombus

Abstract

The presence of intracoronary heavy thrombus burden during PCI often presented a management decision difficulty for the interventionist, and usually played a pivotal role in slow or no-reflow phenomenon, reduced post-PCI myocardial blush, as well as distal embolization, resulting in an increased risk of MACE. Accordingly, choosing the optimal strategy in confronting such problem had been often a challenge during primary PCI in acute STEMI patients. Angiographically, heavy thrombus burden can appear as a cut-off pattern of occlusion in the IRA, presence of a floating thrombus, accumulated thrombus proximal to the occlusion, persistent dye stasis distal to the occlusion, incomplete occlusion with accumulated thrombus more than three times the reference lumen diameter (RLD), with the RLD of the IRA ≥ 4.0 mm, and was graded into 5 grades according to its size and its angiographic description.