1041
4756558020012657113
www.iakardiologie.cz3408040010765133201214233274312354380428447495515563613632675690730769
KAZUISTIKA4286200012665137200272306365424456524597
/4904200012632
CASE4957200012660131190248
REPORT5227200012662120184260325384
The276236001063071103
role288136001063374105137
of303436001063869
intracoronary31193600106155689125166200238274315357397432468
thrombolysisin360336001063071107147201237278310342375392424441482
thrombus-laden410136001063071106147201237278310338368410450482523
coronary464036001063271107148190229265301
artery:495736001063873105137173209223
a5194360010638
case524836001063274108139
report540336001063366101142178209
/27308040010732
Interv280780400107196793136162206
Akut3033804001075391139167
Kardiol.3220804001074587114162180228248264
2024;23(1):43-493504804001074487128168182227271293333350365408449476523565
/41148040010731
INTERVENČNÍ4191804001071978123168215263308366420478499
A47128040010752
AKUTNÍ4786804001075399158202263284
KARDIOLOGIE50918040010745103150211232295337397456477521
In340412001092272
the436412001093080126
long586412001092171122173
term,783412001093075105181200
resolution1007412001093075111161183232263284334384
of1416412001094976
an1516412001094494
abluminal1634412001094395117166242263313357378
thrombus340426001092978106154227277326360
can715426001093982131
lead860426001092165107157
to1032426001092976
stent1123426001093564108157185
malposition,13224260010974116137186235270290319339387436454
which17914260010965114134173221
leads340440001092166110160196
to551440001093079
an645440001094393
increased754440001092170111140185228263308360
risk112944000109305186128
of1273440001094975
stent1364440001093566110160189
thrombosis.1569440001092979108157232283333368389424443
Delaying3404540010960106128171212234284334
stent690454001093666111161191
placement897454001095172116156201276321372401
for1314454001092676106
primary1436454001095180102177220250295
PCI17474540010948100121
has1884454001095093128
been340468001095197143194
investigated550468001092171113157193224245296339369413465
as1031468001094479
an1126468001094494
option12364680010949101131152202252
to1504468001093079
reduce1599468001093075127176217261
this1877468001092979100136
complication.340482001094088163214235256296339368389438488507
However,8634820010958108173217260304333348
the1226482001093079124
DANAMI13664820010959111170224296318
3-DEFER1700482001094574135180222265312
trial34049600109306082127148
reported514496001093076129180211244289342
that882496001093081125155
delayed1063496001095298120165207252305
stenting1394496001093667113164194216266318
had1738496001095195147
no19114960010951101
effect340510001094572102147188220
on5765100010950100
composite692510001094089164216266302323353397
all-cause110551000109446586115158202251287333
mortality,14545100010975124154187231252273303348363
non­18335100010950100150179
-fatal34052400109275498127171192
MI,547524001097294113
or675524001094979
ischemia-driven76952400109215697146191266287329358411440461504548598
revascularization1383524001092973116159194235284305348377398436481510530580630
in340538001092171
non-IRA4365380010950100151180204252310
lesions.771538001092167103124173224259279
Based1075538001094993129175226
on13275380010949100
these1452538001092979125161207
findings,1684538001092650100151173223274309328
delaying340552001095197119162204226276327
routine692552001093079129160181231277
stenting994552001093667111162191213263314
is1333552001092157
not14155520010950100130
recommended1571552001092974116165240316362412340566001095196148
(Class50756600109267798141177212
III;7385660010922446684
LOE8415660010943103148
B)1008566001094973
(2).110056600109267195112
In480580001092271
a5665800010944
meta-analysis6255800010975120150193221264313356376419454474508
of1149580001094975
five123958000109275092136
small13915800010935109152173193
single-center1599580001093656105155176220250292335385340594001093074104
studies468594001093666116167187232268
with760594001096788117167
754951594001094790136
patients,1111594001095296125145190241270306325
direct1460594001095172101145186218
stenting1702594001093666111161190210260310
appeared340608001094394145190233262306357
to721608001093078
improve823608001092195146175223265309
reperfusion,1156608001092973124170199227277312332381431449
as1629608001094378
evidenced1731608001094587108158203253340622001094186139
by504622001095395
a6246220010945
significant694622001093657109159181208232273318369398
increase1117622001092273114144190234270317
in1459622001092172
ST1556622001094592
segment1673622001093683135212258309339
resolution340636001092972107155175223251271319368
and721636001094391140
a8756360010943
decrease931636001095094134162205247281325
in1269636001092169
in-hospital135163600109216997146194228278298326369389
cardiac1753636001094082110159179221259
death.340650001095197141170220239
In604650001092172
this700650001093080101136
study,861650001093667116168211225
there1111650001093080126156201
was13366500010967111147
no15076500010951101
single1632650001093657107158179224
use1881650001095086131
of340664001095077
contemporary441664001094190140170215291342393423467496542
DES10086640010960105151
or1183664001095080
adjunctive1288664001094495117166217258289310354399
medical17116640010976122174195236280301
treatment340678001093058102144172246290339367
(19).721678001092666106129145
Saad880678001094487129179
et1073678001094473
al.116067800109436482
also125567800109446498146
reported1415678001093073124173201233276327
a17556780010944
significant181267800109365610515317334069200109264988131180208
reduction562692001092973124172212243263311361
in937692001092069
infarct102069200109217095138167205236
size127069200109365693137
and1421692001094392142
a15776920010943
lower1634692001092270135178207
incidence1855692001092170109129340706001095093141180223
of576706001094873
heart662706001094993134162192
failure86770600109266888107155182225
hospitalization1106706001094996130179199227269289308345388415435482531
and1650706001094290139
death1802706001095094135163210
in340720001092170
the432720001092978123
case577720001094083118163
of761720001095075
direct858720001095171100144184216
stent1095720001093666110159188
insertion1304720001092170105150179211231280329
without1655720001096687116165214263293
a19697200010943
pre-dilated340734001095179123152203223243285313356406
balloon760734001095194114133182230279
strategy.105373400109356593135163207256298312
However,13797340010958106171214255298327340
the1733734001093078122
major18697340010974116340748001092271100
limitation460748001092141115136165208237257306356
of835748001095076
direct930748001095171100144185216
stent1166748001093565109159187
placement1373748001095172115155198273318367396
in1789748001092170
this187974800109297899133
study340762001093666114165207
was5667620010966109144
the729762001093079124
presence872762001095180124159204254294337
of1228762001095075
a13227620010944
thrombus,1384762001093079108156231282331366384
which17877620010966116136176225
limited340776001092141115135164207258
the612776001092978122
choice748776001094089138158197240
of1002776001095075
stent.1091776001093565108157186204
Other1309776001096292141185214
limitations1537776001092141114135163206235255303353387
of1938776001094974
direct2140412001095171100144185216
stent2374412001093565109159187
insertion2579412001092171105150179211231280330
include2927412001092170110130179229274
underestimated3219412001095099149194223268303332353427470498542593
arterial2140426001094372104148177197240261
size,242042600109365694139156
failure259642600109266990110159188232
to2848426001093078
penetrate2945426001095297147192221250293322366
a33304260010944
tortuous3394426001092977107138187236285320
or3734426001094979
calcified2140440001094184105146166192216261312
lesion,2476440001092267102123172222241
inadequate2741440001092171114165210262311354383427
stent3192440001093667111161190
expansion,3406440001094588139183233268288338388406
and2140454001094392143
late229745400109216493136
stent2448454001093565109158187
malposition,26494540010975118138189238273293322342391441459
which31224540010966116136176225
can3361454001094083133
increase3508454001092170110138183225260305
the2140468001093079124
risk227946800109295085126
of2420468001095075
stent2511468001093565109159187
re-stenosis2713468001093074104139169213262311346366401
or3129468001094978
thrombosis3223468001092978107156230281331365385420
(20).3658468001092670114138154
These2140482001094494138173217
data2371482001095092120163
suggest2548482001093583133182226261290
that2852482001092978120148
direct301448200109507098142182213
stenting3241482001093564108157185205253302
with3557482001096686115164
or3734482001094978
without2140496001096687116164213262291
balloon2445496001095194115135184233282
angioplasty2741496001094493142162211262283325359389433
and/or3188496001094392143173218247
thrombus3449496001093079107155230280329363
aspiration2140510001094378128149177220249269318367
can2521510001094084133
be2668510001095196
applied2778510001094394145166186230281
safely3073510001093679105149170212
(Class329951000109267595138172207
I;3520510001092139
LOE35735100010942102146
A)3733510001095579
(2),214052400109256891106
particularly2260524001095193121152172211259279321349369410
in2684524001092169
certain2766524001094083111143185205253
ACS30335240010954103146
patients3193524001095093121141184233261296
with3503524001096586114162
low3679524001092169133
TIMI2140538001094566138160
thrombus2321538001093079108156231282331366
levels2709538001092166108152173207
(1–3).2938538001092667108153175191
To3151538001094588
date,3261538001095193122166183
there3466538001093079124153197
has3685538001095093127
been2140552001095197142192
no2356552001095099
single2479552001093656105155176221
strategic272455200109356594138166210261282322
recommendation3069552001093074115163238313358408458501530550599649
in3742552001092170
the2140566001093078123
guidelines2277566001095098118168212233253302346381
that2672566001092978120148
would28345660010966114163183233
fit308156600109264978
our3173566001094998126
case3313566001094083117162
scenario.3489566001093575118167209238258306323
The2140580001094597143
large230758000109226595145191
thrombus2522580001093181110160236288338374
burden29205800010952102132183229279
(TIMI322458000109267395169191
thrombus3439580001093081110160236287338373
grade2140594001094977119167211
>23635940010953
3)2429594001094566
and2508594001094390139
slow2660594001093554102165
blood2838594001095070117165215
flow306659400109254795158
(TIMI323759400109257090160181
flow343059400109264896159
grade3602594001094977118167210
0)2140608001094772
require2236608001093076128178199229274
a25356080010944
special2604608001093687134176197240262
management28906080010977121171215266312389435486515
approach.3430608001094496148178228272313363383
In2140622001092271
fact,2229622001092770110141160
we24076220010967111
perform2536622001095197126154203232307
several2862622001093680123166195239259
strategies,314062200109356594137166210260281325360379
namely3537622001095093167212233276
MAT,21406360010973129168181
balloon2345636001095195116137187237287
angioplasty,2656636001094494144165215266288331366396441455
and3135636001094494145
intracoronary3304636001092171100129173213262291340391434463508
thrombolysis,2140650001093079108156231281331352394429449484503
during2660650001095199128149198248
PCI.29256500010948100120139
Aspiration21406750014370117182208242298334359422487
Thrombectomy26566750014356122157219318384444498539601699750
MAT22806920010973129169
is2475692001092157
one25586920010949100147
of2730692001095077
the2833692001093080127
most29856920010976127163194
frequently3205692001092657103155205251302332354397
used3628692001095086132184
thrombectomy2140706001093080109159234286332374406455530572
methods27347060010975121151201251303339
for3094706001092777107
primary3223706001095181102177221251296
PCI35417060010948101122
because36857060010951972140720001094085134170216
the2378720001092979125
procedure2525720001095181131172217269318348393
is2940720001092157
simple3019720001093556132183205251
and3292720001094393145
has3459720001095093129
a36107200010943
low3675720001092171137
risk214073400109305289132
of2299734001095078
vascular2403734001094489126168219241286316
injury274673400109217395146176223
and2996734001094495148
distal3170734001095274111142188210
embolism.34077340010946123176228250272309386406
Several2140748001094592136181212257279
small-scale24457480010937113158180201231268310355377424
or2895748001095081
single-center3002748001093658109161183230261305350402432478508
studies3536748001093768119171193240276
and2140762001094394145
one23087620010949100145
meta-analysis24767620010975121151196225269319362384427463484519
of3018762001095076
113117762001094684
small32237620010936111155176197
trials344376200109306081125146182
suggest36477620010936851362140776001095096132163
that2322776001093080123153
there2495776001092979125155200
may27157760010975118160
be2894776001095198
an3011776001094494
advantage3124776001094395139183233262307357403
to3547776001092978
MAT36457760010972128167
in394062001092170
primary402562001095079100173216245289
PCI432962001094799119
(21).446362001092569110129145
However,4623620010958107172216258301330344
data498262001095093122165
from516262001092655104178
several535562001093579122165194237258
studies394076001093566115166187232268
to422376001093078
date431776001095194123167
still45007600109356687108128
report464476001092974125176205238
inconsistent489776001092171111159209244265300331375425454
results536776001092974109158179209245
in394090001092171
terms403090001093075105180216
of426590001094976
the436090001093080126
benefit450590001095197148193220244275
in479990001092171
primary488990001095181103178221251297
PCI.5205900010948100121141
The40801040010946100147
TASTE4258104001094698146194241
(n4530104001092676
>46361040010955
7,000)4722104001094759108158208234
and4987104001094597151
TOTAL51681040010946110156208252
(n5451104001092676
>55571040010956
10,000)3940118001094689107154202250275
randomized4232118001093074124175225301322361406458
controlled4708118001094089140169199248270291337389
trials511511800109305981124146181
showed5314118001093686136202247298
no39401320010950101
benefit4067132001095198149195223247278
of4370132001095077
MAT44731320010973129169
on46681320010950101
mortality,47951320010975126156189234256277308353369
re-hospitalization,5189132001093076106158209245297319349394394014600109214382128158179229280300
stent4265146001093667113164193
thrombosis,4484146001093081110160237289340376397433452
or4962146001095080
overall5068146001095093138168213234256
clinical535014600109406283133155196241262
outcome,39401600010949100130169218294340358
while43231600010966117138159205
the4553160001092979125
TOTAL47031600010944105149199242
study4969160001093667117168211
also5205160001094365100150
reported53801600010929751261772073940174001093075127
an4092174001094494
increased4212174001092171112142187231267312365
rate4602174001093074104148
of4776174001094976
stroke487817400109356696146189233
incidence5137174001092171112133185231281322367
(1,552917400109266883
22–25).3940188001094693137180226251268
However,42341880010959110176221265310340355
1–5%4615188001094789135205
of4846188001095077
randomized4948188001093074125177227303325364410462
patients54361880010951961261473940202001094596125162
in4126202001092172
these4222202001093080125161207
studies4454202001093566116167189234270
switched47482020010936103125155195245291343
from5115202001092657106182
PCI53212020010948101122
alone54672020010944651153940216001095096
to4059216001093079
MAT41612160010972128167
(1,435221600109256782
22).4457216001094693116133
In4614216001092171
the4709216001092979125
subgroup4857216001093685137188218267317369
with5249216001096688118168
high5440216001095071122172
thrombus3940230001093080109159234286336372
burden43282300010952102131182228278
(TIMI462323000109267395168191
thrombus4830230001093080109159235286336372
grade5218230001095180124176221
≥54562300010954
3),552623000109466987
MAT39402440010972128167
was41282440010967110146
associated4295244001094379114164206227270300345397
with4712244001096788119169
lower4901244001092272137182212
cardiovascular5134244001094085114165186236279323359400449394025800109216595
mortality40602580010976126156189233255276306352
(2.5%443725800109267190139209
vs.467225800109437999
3.1%;4796258001094765106173192
HR50132580010959108
0.80,5147258001094665113160179
95%5351258001094792162
CI5539258001095273
0.65–0.98;3940272001094665112157204253272317364382
P43392720010947
=44032720010954
0.03)4473272001094665111157180
and4669272001094494145
a48302720010944
higher4890272001095071122172218248
incidence5154272001092172112133185230281322366
of5537272001094976
stroke394028600109366796146189233
or4199286001094979
transient4304286001093059104154189210256307336
ischemic466628600109215697147193269290331
attack5022286001094474106150191233
(0.9%528128600109257189134207
vs.551328600109448099
0.5%;3940300001094665113183202
odds41673000010949101152188
ratio4380300001092973103124174
[OR]4579300001092585134159
1.56,4763300001094661110156175
95%4963300001094691161
CI5149300001095273
1.02–2.42,5247300001094661107152195237257303347365
P39403140010948
=40063140010953
0.03)4077314001094665112157180
(26).4275314001092570115139156
These4449314001094496141177223
results4690314001092974110160181211248
may49563140010975119160
be5134314001095197
related524931400109307597140170215267
to5533314001093079
thrombus3940328001092978106154227277326360
aspiration4315328001094277126147175218246266315364
and4693328001094391141
inadequate4849328001092069111161205255303345374417
restoration52803280010929731081371852142562853053940342001094999
of4055342001095076
coronary4147342001094089118168218261290336
blood4499342001095173122173224
flow4739342001092650100165
in4920342001092171
cases5007342001094084119165201
of5224342001094975
massive53153420010975118154189210253298
intracoronary3940356001092171101130174215264294343394437467513
thrombosis.4472356001092979109158234286336372393428448
Randomized4080370001094789137185233305325361404454
controlled4546370001094086134161189236256275318368
trials492637000109295776117137170
have5109370001094990130172
reported5293370001092972121169197227270319
that3940384001093078121149
rheolytic4103384001092978123172193234266286325
thrombectomy4442384001093079107155229279324364395443517557
is5013384001092155
more50823840010975124152196
effective5292384001094571100144184215235277321
than3940398001092977119167
MAT41203980010972125163
in4296398001092169
thrombus4378398001093078105153226276324358
removal4749398001092972145194234276296
and5059398001094291140
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STEMI4956412001094489133204225
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rheolytic4273426001092977120168188229260279317
thrombectomy4603426001093077104152224273317356386433505545
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catheter5314426001093981109156200228270298
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a41144400010943
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saline466144000109357897117165209
jet,488344000109226594112
creating5008440001094068111153181201249298
a53194400010943
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6004596454001094694142
mmHg47624540010976152211263
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a46454680010944
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However,39404960010959109175220263307337351
study4315496001093666116167210
reports4549496001093075126176206238275
failed484849600109267191112157209
to5081496001093079
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PCI41315240010948100120
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PCI.5477622001094798117135
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an5080664001094390
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stents4024734001093564105153180214
(2).424973400109266889104
Simple4364734001094462134182202245
balloon4620734001095192111130177224272
angioplasty4903734001094390138157204253272313346374416
can5331734001094081128
also547173400109436194141
be3940748001095399
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the4680748001093181126
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the5114762001092978122
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the4160776001093077121
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wall53777760010966108128147
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