No-Stent Management of High Coronary Thrombus Burden in Young Patients with STEMI: A Four-Case Series.
Muhammed Emre Güleşir, Mehmet İnanır, Berkay Topal et al.
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Case in brief
The report describes four young male patients (≤50 years old) presenting with STEMI and a large coronary thrombus without clearly demonstrated flow-limiting severe atherosclerotic stenosis. They were managed without permanent stent implantation using tirofiban-based antithrombotic therapy, with mechanical reperfusion when needed to restore epicardial flow. Treatment was followed by substantial thrombus regression. Management was guided by clinical stabilization and TIMI flow, with angiographic follow-up.
What made this case unusual
The cases involved substantial coronary thrombus without a clearly demonstrated flow-limiting fixed lesion, prompting a no-stent approach rather than routine stent implantation.
Diagnostic / clinical pearl
In selected patients with high thrombus burden but preserved coronary flow and no clearly demonstrated flow-limiting fixed lesion, assess the need for mechanical reperfusion and stenting individually, guided by clinical status, TIMI flow, and close angiographic follow-up.