Utilization Of Eptifibatide For Treatment Of Acute Coronary Thrombus After Severe Dissections As A Bail-Out Procedure In Anterior Stemi

Abstract

Acute coronary thrombus formation during primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) remains a challenging complication, particularly when associated with severe dissections. Optimal strategies to manage this life-threatening scenario are not well established. We report a case of a 58-year-old male presenting with anterior STEMI who underwent primary PCI. During intervention, severe iatrogenic dissection occurred in the distal left anterior descending artery, resulting in large thrombus burden and impaired distal flow. Multiple aspiration thrombectomy attempts and balloon dilatations failed to resolve the thrombus. As a bail-out strategy, intracoronary eptifibatide bolus followed by intravenous infusion was administered, leading to marked thrombus resolution and restoration of TIMI 3 flow 24 hour. After OCT approach in the next day, patient was stented with good results.  The patient remained hemodynamically stable with no periprocedural complications, and follow-up echocardiography demonstrated preserved left ventricular function. Eptifibatide, a glycoprotein IIb/IIIa inhibitor, is generally reserved for high thrombus burden situations in STEMI. Its role as a rescue therapy post-dissection-induced thrombosis is rarely reported. In this case, eptifibatide effectively lysed the thrombus and improved microvascular perfusion, avoiding additional mechanical interventions. This aligns with prior studies indicating eptifibatide’s rapid platelet aggregation inhibition and potential to reduce thrombus burden (Marlino et al., 2019; Stone et al., 2001). Intracoronary and intravenous eptifibatide can serve as a safe and effective bail-out therapy for acute coronary thrombus formation secondary to severe dissections in STEMI patients when conventional mechanical strategies fail. Further studies are needed to establish standardized protocols for its utilization in such complex scenarios.