First and foremost is
Avoid the procedure if not really indicated.A lesion which has more thrombus load than a plaque and it is , subcritical and not limiting the flow , PCI may be inappropriate especially if the ACS is stabilised.
- Adequate anticoagulation along with 2b 3a blockers should be used
- Predilatation should be minimally used or to avoided.Direct stenting preferred.
- In primary PCI suction devices (Export etc may be useful)
- Distal protective devices are “hyped up devices” rarely useful in an occasional patient with good distal vessel diameter.
- Pseudo stent approximati(fig 1) may occur. A Layer of thrombus may get plastered between stent and the vessel wall.In the post PCI phase , with intense anticoagulation and antiplatelet regimen this layer may get dissolved and stent may lose it’s grip and may dislodge or migrate.Another possibility is the dead space beneath the stent becomes a potential site for future thrombus and ACS.
Fig 1
- To prevent this complication , high pressure inflations and Post procedure IVUS (Intra vascualr ultraound may be done to ascertain lack of thromus between stent/vessel wal interface)
- Drug eluting stent evoked a special concern , when used in thrombotic milleu.This , has now been proven to be safe
Dr.S.Venkatesan MD 