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The management of intracoronary thrombus remains a challenge to the interventional cardiologist. Continuous thrombus formation, inadequate assessment of vessel diameter and plaque length, and distal embolization are adverse factors in this setting. In this paper, we present a novel strategy for coronary thrombus management with intracoronary alteplase using a microcatheter at a 1 mg/h dose for 12 hours. Sixteen patients were assigned to alteplase infusion and 15 to the conventional strategy. In the alteplase group, 50% of patients had TIMI 0 thrombus, versus 40% with TIMI 2 thrombus in the conventional group. In the alteplase group, eight stents were used, compared with 22 stents in the conventional group. The mean stent length was 18.4 ± 2.84 mm in the alteplase group and 21.45 ± 3.09 mm in the conventional group. No no-reflow cases were observed in the alteplase group, versus four cases in the conventional group. There were no hemorrhagic complications in either group. This method may be a valid strategy for the management of coronary thrombus. [ABSTRACT FROM AUTHOR]

Background: In patients with acute coronary syndrome the first 24 hours of evolution, the state of inflammation and platelet activation are higher, especially if the mechanical operations are added to restore the flow, including stenting, which favors the phenomenon of "no-reflow". Objective: To determine whether the deferral of the application of the stent in patients with acute myocardial infarction event rate decreases no-reflow. Methods: Observational, descriptive, longitudinal, and comparative ambispective study in the Hospital Central Militar (Mexico) 12 hours of evolution. Two groups were formed: the first received immediate treatment and the second was deferred, on average, 64 hours. Results: 26 patients, 23 males (88%) and 3 women (12%) were studied. A 11 underwent angioplasty and stenting plus deferred ball over (42%) (group 1) and 15 were treated with angioplasty and stenting immediately (58%) (group 2). In the acute event group 1 smaller proportion of noreflow although not statistically significant for the size of the sample was observed. In either group, there were deaths. Conclusions: The deferral of the implementation of the stent in patients with acute myocardial infarction resulted in lower event rate of no-reflow. To confirm the benefits and safety of this procedure will be necessary to study a larger sample of patients. [ABSTRACT FROM AUTHOR]