A 2-step optical coherence tomography guided therapeutic approach to acute myocardial infarction secondary to stent thrombosis.

UNLABELLED: Myocardial infarction secondary to stent thrombosis has high mortality and recurrence rate. Emergency PCI has high risk of no-reflow. We used a 2-step approach of early recanalization with minimal mechanical intervention followed by delayed PCI 1-2days later guided by Optical Coherence Tomography (OCT). From October 2011 to December 2013, we treated 5 patients with this approach. Time from early recanalization to the delayed definitive PCI was 1day (median, range 1-3days). All the OCT images were diagnostic with a clear view of the underlying structures.

SUMMARY: A 2-step approach to treat stent thrombosis appears beneficial with low incidence of peri-procedural thrombosis or no-reflow phenomena during the second step, and superb OCT imaging.