Abstract

Majority of the STEMI (ST elevation myocardial infarction) cases especially young patients(<50years) have significant amount of thrombus in the culprit arteries. The presence of large thrombus causes decrease in myocardial perfusion at microcirculatory level by embolization either spontaneously or during an attempt of PCI causing adverse effects. Intracoronary delivery of thrombolytic agent in STEMI patients with large thrombus burden is an effective alternative to achieve recanalization of coronaries without stenting. Case series summary: In the present case series seven patients with age ≤ 50 years who presented with acute STEMI and angiogram showing large thrombus were included. One third of systemic dose of Tenecteplase(TNT) was given intracoronary and check angiogram was done after 24 hours to see the patency of the vessel. We achieved successful recanalization in all the patients without need for stenting with no bleeding complications. Conclusion: Low dose intracoronary thrombolysis is reasonable option in establishing coronary blood flow in thrombotic occluded coronaries in young STEMI patients. Careful selection of patients and quantification of thrombus is important to achieve optimal results with no bleeding complications.

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