A clinical case of the use of systemic thrombolysis with Alteplase after an unsuccessful primary percutaneous coronary intervention in a patient with acute ST-segment elevation myocardial infarction

Background. In patients with ECG acute ST-segment elevation myocardial infarction on an electrocardiogram, primary percutaneous coronary intervention is the preferred reperfusion strategy. However, there are a certain percentage of PCI failures that may be related to the complexity of the anatomy of the lesion and the technical problems that arise during the intervention itself. Due to the lack of evidence basis, there are no accurate data that open surgery (coronary artery bypass grafting) in case of unsuccessful coronary intervention will be of potential benefit for the patient, and time delays associated with preparation, in our opinion, could negatively affect outcomes in a patient with acute ST-segment elevation myocardial infarction. Description of the clinical case. This clinical example describes the use of sistemic thrombolysis with Alteplase after an unsuccessful primary percutaneous coronary intervention with a positive clinical effect. Conclusion. Despite the improvement of the stenting technique, there are still a certain percentage of failures of percutaneous coronary intervention, including those related to the inability to deliver the stent to the target area. Thus, the further management strategy for patients with ST-segment elevation myocardial infarction depends primarily on an individual benefit-risk evaluation in a particular clinical situation.

percutaneous coronary intervention, acute ST-segment elevation myocardial infarction, thrombolysis, clinical case