Clot Management in Primary Percutaneous Coronary Intervention: Fighting Your Enemy

Clot is often the enemy during primary percutaneous coronary intervention. Taking inspiration from ancient wisdom of fighting a war, an interventionist should first look into strength enemy, i.e. assess thrombus burden, by both Thrombolysis in MI grade and angiographic features. This to be followed choosing appropriate strategy: attack – aspiration mechanical thrombectomy; surround pharmacological therapy, including oral parenteral antiplatelet therapy intracoronary thrombolytic therapy; avoid stenting strategies direct deferred stenting; battle under distal protection device or across local obstructive thrombus; flee move intervention optimal antithrombotic circulatory support when flow fails regained. Of note, most these have not been demonstrated beneficial on routine use. The key remains adopt different selectively appropriately scenarios.