CA LÂM SÀNG BIẾN CHỨNG HUYẾT KHỐI TRONG NHỒI MÁU CƠ TIM CẤP NÊN HÚT HAY KHÔNG HÚT?

Abstract

Introduction: Coronary artery thrombus occurs due to the rupture or erosion of a pre-existing atherosclerotic plaque within the coronary lumen. This is a common pathological finding in acute coronary syndrome (ACS), especially in ST-elevation myocardial infarction (STEMI). It has a substantial impact on the efficacy and outcomes of percutaneous coronary intervention (PCI), being a strong predictor of periprocedural complications, distal embolization, and stent thrombosis. Current guidelines from major cardiology societies such as the European Society of Cardiology (ESC), American College of Cardiology (ACC), and the Vietnam National Heart Association recommend against the routine use of manual thrombus aspiration in PCI for acute myocardial infarction due to its associated complications. This paper presents a clinical case of acute myocardial infarction with a serious complication related to thrombus aspiration and discusses the clinical implications and preventive strategies derived from this experience. Methods: A Case Report. Results: We report a case of acute ST-elevation myocardial infarction with a large thrombus burden identified on coronary angiography. Manual thrombus aspiration was performed, resulting in occlusion of non-culprit branches. This led to cardiogenic shock and cardiac arrest, followed by successful resuscitation. Based on this experience, we propose several preventive measures to mitigate the risks of thrombus aspiration in similar clinical scenarios. Conclusion: Routine thrombus aspiration is no longer recommended in acute coronary syndrome management due to the risk of serious complications, including embolization to non-culprit coronary arteries. It is crucial to consider alternative strategies tailored to the patient's risk profile to prevent adverse outcomes.