Intracoronary stenting in acute myocardial infarction

Stent implantation into an infarct-related artery during acute myocardial infarction is generally contraindicated because of the risk of stent thrombosis. We report on 3 patients who had successful stenting for an acute occlusive dissection that developed during direct infarct coronary angioplasty and was refractory to conventional prolonged balloon dilatation, with good long-term clinical and angiographic results. The prerequisites for success include proper premedication, presence of only a minimal amount of thrombus in the infarct-related artery, liberal use of intracoronary thrombolytic therapy, as perfect an angiographic result as possible, as well as careful and aggressive post-stenting anticoagulation.