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Feb 25, 2025
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Abstract
Direct stent implantation is widely recommended for the management of patients who have acute myocardial infarction with ST-segment elevation. However, in situations where there is HTB in the affected artery, stenting may increase the risk of no flow phenomenon. Delaying stenting may reduce complications.
A 45-year-old man presented with symptoms suggestive of acute right ventricular infarction that started 8 hours before admission. The patient underwent an echocardiogram which showed an ejection fraction of 36%. Pre-PCI pharmacotherapy was administered. Coronary angiography showed a grade IV occlusion in the mid-LAD branch as well as a thrombus in the mid-RCA with TIMI 2 flow. Thrombus aspiration and balloon inflation were performed, but HTB persisted. DS was decided, with additional Enoxaparin 0. 6 cc twice daily. Subsequent angiography after 34 hours, showed CAD in three coronary artery branches with the RCA still showing complete occlusion with HTB. A stent implantation procedure was performed in the mid-RCA segment The final result achieved was TIMI 3 blood flow, with no residual stenosis.
HTB can also be diagnosed based on the TIMI thrombus risk classification. The main goal of deferred stenting is to minimize complications such as the slow-flow phenomenon of distal embolization.
It is important to emphasize that a routine DS strategy has not shown clear benefit and is not recommended.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
Kurniawan, C., Widito, S., & Putri, V. (2025). Deffered Stenting in High Thrombus Load: A Case Report . Jurnal Klinik Dan Riset Kesehatan, 4(2), 151-159. https://doi.org/10.11594/jk-risk.04.2.8
References
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2. Ibanez B, James S, Agewall S, Antunes MJ, Buc-ciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myo-cardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2018;39:119-177.
3. Braunwald E. HEART DISEASE. 12th ed. (Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. ). Philadelphia: Elsevier; 2022.
4. Ke D, Zhong W, Fan L, Chen L. Delayed versus immediate stenting for the treatment of ST-elevation acute myocardial infarction with a high thrombus burden. Coron Artery Dis 2012 Wolters Kluwer Heal Lippincott Williams Wil-kins. 2012;23:497-506.
5. Lønborg J, Engstrøm T, Ahtarovski KA, Nepper-christensen L, Helqvist S, Vejlstrup N, Kyhl K, Schoos MM, Ghotbi A, Bertelsen L, Holmvang L, Pedersen F, Clemmensen P, Backer O De. Myocardial Damage in Patients With Deferred Stenting After STEMI. 2017;69.
6. Pradhan A, Bhandari M, Vishwakarma P, Sethi R. Intervention Deferred Stenting for Heavy Thrombus Burden During Percutaneous Coro-nary Intervention for ST-Elevation MI Deferred Stenting for Heavy Thrombus Burden During PCI for STEMI Deferred Stenting Strategy : A Primer. Eur Cardiol Rev. 2021.
7. Carrick D, Oldroyd KG, Mcentegart M, Haig C, Petrie MC, Eteiba H. A Randomized Trial of De-ferred Stenting Versus Immediate Stenting to Prevent No- or Slow-Reflow in Acute ST-Segment Elevation Myocardial Infarction ( DE-FER-STEMI ). J Am Coll Cardiol. 2014;63.
8. Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G, et al. Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. J Am Coll Cardiol. 2017;70:1-25.
9. Kumar R, Khan KA, Shah JA, Ammar A, Khowaja S, Sial JA, Kazmi S, Karim M. ORIGINAL ARTICLE QUANTIFICATION OF THROMBUS BURDEN AS AN INDEPENDENT PREDICTOR OF INTRA-PROCEDURAL NO-REFLOW IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION UNDERGOING PRIMARY PERCUTANEOUS CORONARY REVASCULARIZATION. J Ayub Med Coll Abbottabad 2022. 2022;34:288-294.
10. Kelbæk H, Høfsten DE, Køber L, Helqvist S, Kløvgaard L, Holmvang L, Jørgensen E, Peder-sen F, Saunamäki K, Backer O De, Bang LE, Kofoed KF, Lønborg J, Ahtarovski K, Vejlstrup N, Bøtker HE, Terkelsen CJ. Deferred versus conventional stent implantation in patients with ST-segment elevation myocardial infarc-tion ( DANAMI 3-DEFER ): an open-label , ran-domised controlled trial. :2199-2206.
11. Magdy AM, Demitry SR, Ali HH, Zaky M, Abd M, Hady E, Ghany MA. Stenting deferral in primary percutaneous coronary intervention : exploring benefits and suitable interval in heavy thrombus burden. Egypt Hear J. 2021.
12. Ren H, Zheng Y, Hu X, Yang Y, Zhang Y, Sun Y, Li B, Tian T, Wubuli D. High thrombus burden : a review of mechanisms and treatments. Int J Clin Exp Med. 2019;12:13068-13078.
13. Xiao Y, Fu X, Wang Y, Fan Y, Wu Y, Wang W, Zhang Q. Effects of different strategies on high thrombus burden in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary catheteriza-tion. 2019:555-563.
14. Tanboga IH, Topcu S, Aksakal E, Kalkan K, Se-vimli S, Acikel M. Determinants of Angiograph-ic Thrombus Burden in Patients With ST-Segment Elevation Myocardial Infarction. Clin Appl Thromb 20(7. 2014.
15. Scarparo P, Gameren M Van, Wilschut J, Dae-men J, Dekker WK Den. Impact of thrombus burden on long ‑ term clinical outcomes in pa-tients with either anterior or non ‑ anterior ST ‑ segment elevation myocardial infarction. J Thromb Thrombolysis. 2022:47-57.
16. Tabl MA, El-Rabbat KE, El-Keshk ES, Gharib GM. Journal of Cardiovascular Medicine and Deferred stent implantation in patients with ST segment elevation myocardial infarction with high thrombus burden. J Cardiovasc Med Cardiol. 2019;6:1-5.
17. Jolly SS, Cairns JA, Lavi S, Cantor WJ, Bernat I, Cheema AN, Moreno R, Kedev S, Stankovic G, Rao S V, Meeks B, Chowdhary S, Gao P, Sibbald M, Velianou JL, Mehta SR, Tsang M, Sheth T. Thrombus Aspiration in Patients With High Thrombus Burden in the TOTAL Trial. 2018;72.
18. Satılmış S, Durmuş G. Predictive accuracy of CHA 2 DS 2 -VASc score in determining the high thrombus burden in patients with non-ST-elevation myocardial infarction. Acta Cardiol. 2020;0:1-7.
19. Høfsten DE, Kelbæk H, Helqvist S, Kløvgaard L. The Third DANish Study of Optimal Acute Treatment of Patients with ST-segment Eleva-tion Myocardial Infarction : Ischemic postcon-ditioning or deferred stent implantation versus conventional primary angioplasty and complete revascularization versus treatmen. Am Heart J. 169:613-621.
20. Belle L, Motreff P, Mangin L, Rangé G, Marcaggi X, Marie A, et al. Comparison of Immediate With Delayed Stenting Using the Min imalist Immediate Mechanical Intervention Approach in The MIMI Study. Circ Cardiovasc Interv. 2016:1-9.
21. Kim JS, Lee HJ, Yu CW. Myocardial Infarction INNOVATION Study ( Impact of Immediate Stent Implantation Versus Deferred Stent Im-plantation on Infarct Size and Microvascular Perfusion in Patients With ST-. Circ Cardiovasc Interv. 2016:1-9.
22. Hu X, Yang X, Zhou X, Li2 X, Dong H, Zhou Y. Evaluating the Role of Deferred Stenting in ST-Segment Elevation Myocardial Infarction Pa-tients Presented with High Thrombus Burden : A Systematic Review and Meta-Analysis. Ann Cardiol Vasc Med Meddocs. 2021;4.
23. Isaaz K, Gerbay A. Correspondence Deferred stenting in acute ST elevation myocardial in-farction. Lancet. 2016;388:1371.
24. 2Kelbæk H, Engstrøm T, Ahtarovski KA, Lønborg J, Tilsted H, Raungaard B, Ravkilde J, Aaroe J, Eggert S. Deferred stent implantation in patients with ST-segment elevation myocar-dial infarction : a pilot study. EuroIntervention 2013;8:1126-1133. 2013.
25. Sakellariou XM, Katsanos GI, Efstathopoulos AP, Sfairopoulos DG, Stamatis K V, Pappas SD, Kolettis TM, Nikas DN. Should Deferred Stent-ing Still Be Considered in ST-Elevation Myo-cardial Infarction with High Thrombus Bur-den ? J Cardiovasc Dev Dis Commun. 2021:2-5.
26. Luo D, Yang X, Hu X, Liu J, Wang C, Ye J. Non-stenting strategy is not inferior to stent im-plantation in patients with acute ST-segment elevated myocardial infarction and high thrombus burden and intermediate stenotic culprit lesion. Ann Palliat Med. 2021.
27. Ahtarovski KA, Nepper-christensen L, Helqvist S, Vejlstrup N, Kyhl K, Schoos MM, Ghotbi A, Bertelsen L, Holmvang L, Pedersen F, Clem-mensen P, Backer O De. Myocardial Damage in Patients With Deferred Stenting After STEMI. J Am Coll Cardiol. 2017;69.
28. Publishers M, Cardiovascular G, Prevention HD, Cardiovascular G, Prevention HD. Evaluating the Role of Deferred Stenting in ST-Segment Elevation Myocardial Infarction Patients Presented with High Thrombus Burden : A Systematic Review and Meta-Analysis. 2021;4.
29. Çınar T, Şaylık F, Akbulut T, Asal S, Selçuk M, Çiçek V, Orhan AL. The association between whole blood viscosity and high thrombus bur-den in patients with non-ST elevation myocar-dial infarction. 2022:429-435.
30. Tanboga IH, Topcu S, Aksakal E, Kalkan K, Se-vimli S, Acikel M. Determinants of Angiograph-ic Thrombus Burden in Patients With ST-Segment Elevation Myocardial Infarction. 2014.
31. Hurst JW. Hurst’s The Heart. Vol 65. (Fuster V, Harrington RA, Narula J, Eapan ZJ, Vaishnava P, eds. ). ; 2017.
32. Svilaas T, Horst ICC Van Der, Zijlstra F. Throm-bus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study ( TAPAS )— Study design. Am Heart J. 2006:1-7.
33. O’Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, De Lemos JA, et al. 2013 ACCF/AHA guideline for the management of st-elevation myocardial infarction: A report of the American college of cardiology foundation/american heart association task force on practice guidelines. J Am Coll Cardiol. 2013;61:78-140.
34. Keeley EC, Boura JA, Grines CL. Primary angio-plasty versus intravenous thrombolytic thera-py for acute myocardial infarction : a quantita-tive review of 23 randomised trials. 2003;361.
35. Mahmoud AN, Elgendy AY, Mentias A, Elgendy IY. Deferred or immediate stent implantation for primary percutaneous coronary intervention : A meta-analysis of randomized trials. Wiley Period Inc. 2017:1-5.
36. Maria GL De, Oikonomou EK, Wolfrum M, Dm RPC, Mbbs APB. Role of deferred stenting in patients with ST elevation myocardial infarction treated with primary percutaneous coronary intervention : A systematic review and meta-analysis. Wiley J Interv Cardiol. 2017:1-10.
37. Harbaoui B, Courand P, Besnard C, Dauphin R, Cassar E, Lantelme P. Deferred vs immediate stenting in ST elevation myocardial infarction: Potential interest in selected patients. Presse Med. 2015;44:e331-e339.
38. Gonzalo N, Barlis P, Serruys PW, Garcia-Garcia HM, Onuma Y, Ligthart J. Incomplete Stent Ap-position and Delayed Tissue Coverage Are More Frequent in Drug-Eluting Stents Implanted During Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction Than in Drug-Eluting Stents Implanted for Stable /. 2009;2:445-452.
39. Trial H, Guo N, Maehara A, Mintz GS, He Y, Xu K, Wu X, Lansky AJ, Witzenbichler B, Guagliumi G, Brodie B, Kellett MA, Dressler O, Parise H, Mehran R, Stone GW. Acute and Late Stent Malapposition After Primary Intervention in Patients With Acute Myocardial Infarction An Intravascular Ultrasound Substudy of the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction. 2010:1077-1084.
40. Guyton AC, Hall JE. Guyton And Hall Textbook of Medical Physiology. Twelfth. (Schmitt W, Gruliow R, Laura Stingelin, eds. ). Philadelphia: Saunders Elsevier; 2011.
41. Pradhan A, Bhandari M, Vishwakarma P, Sethi R. Intervention Deferred Stenting for Heavy Thrombus Burden During Percutaneous Coro-nary Intervention for ST-Elevation MI Deferred Stenting for Heavy Thrombus Burden During PCI for STEMI Deferred Stenting Strategy : A Primer. 2021.
42. Li W, Wenhua H, Zhou Y, Guo Y. Immediate versus deferred percutaneous coronary inter-vention for patients with acute coronary syn-drome : A meta-analysis of randomized con-trolled trials. PLoS One. 2020:1-16.
43. Gaziano JM, Brotons C, Coppolecchia R, Cricelli C, Darius H, Gorelick PB, Howard G, Pearson TA, Rothwell PM, Ruilope LM, Tendera M, Tognoni G. Use of aspirin to reduce risk of ini-tial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a ran-domised, double-blind, placebo-controlled tri-al. Lancet. 2018;392:1036-1046.
44. Marquis-Gravel G, Jolicoeur EM. The Value of Deferred Stenting in Acute Myocardial Infarc-tion: Can Minimalist Immediate Mechanical In-tervention Do It All? Can J Cardiol. 2016;32:935-937.
45. Segment S-, Myocardial E, Yong CM, Tamis- JE. “ Goldilocks ” Approach to Deferred Stenting. 2022:1-4.
2. Ibanez B, James S, Agewall S, Antunes MJ, Buc-ciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myo-cardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2018;39:119-177.
3. Braunwald E. HEART DISEASE. 12th ed. (Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. ). Philadelphia: Elsevier; 2022.
4. Ke D, Zhong W, Fan L, Chen L. Delayed versus immediate stenting for the treatment of ST-elevation acute myocardial infarction with a high thrombus burden. Coron Artery Dis 2012 Wolters Kluwer Heal Lippincott Williams Wil-kins. 2012;23:497-506.
5. Lønborg J, Engstrøm T, Ahtarovski KA, Nepper-christensen L, Helqvist S, Vejlstrup N, Kyhl K, Schoos MM, Ghotbi A, Bertelsen L, Holmvang L, Pedersen F, Clemmensen P, Backer O De. Myocardial Damage in Patients With Deferred Stenting After STEMI. 2017;69.
6. Pradhan A, Bhandari M, Vishwakarma P, Sethi R. Intervention Deferred Stenting for Heavy Thrombus Burden During Percutaneous Coro-nary Intervention for ST-Elevation MI Deferred Stenting for Heavy Thrombus Burden During PCI for STEMI Deferred Stenting Strategy : A Primer. Eur Cardiol Rev. 2021.
7. Carrick D, Oldroyd KG, Mcentegart M, Haig C, Petrie MC, Eteiba H. A Randomized Trial of De-ferred Stenting Versus Immediate Stenting to Prevent No- or Slow-Reflow in Acute ST-Segment Elevation Myocardial Infarction ( DE-FER-STEMI ). J Am Coll Cardiol. 2014;63.
8. Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G, et al. Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. J Am Coll Cardiol. 2017;70:1-25.
9. Kumar R, Khan KA, Shah JA, Ammar A, Khowaja S, Sial JA, Kazmi S, Karim M. ORIGINAL ARTICLE QUANTIFICATION OF THROMBUS BURDEN AS AN INDEPENDENT PREDICTOR OF INTRA-PROCEDURAL NO-REFLOW IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION UNDERGOING PRIMARY PERCUTANEOUS CORONARY REVASCULARIZATION. J Ayub Med Coll Abbottabad 2022. 2022;34:288-294.
10. Kelbæk H, Høfsten DE, Køber L, Helqvist S, Kløvgaard L, Holmvang L, Jørgensen E, Peder-sen F, Saunamäki K, Backer O De, Bang LE, Kofoed KF, Lønborg J, Ahtarovski K, Vejlstrup N, Bøtker HE, Terkelsen CJ. Deferred versus conventional stent implantation in patients with ST-segment elevation myocardial infarc-tion ( DANAMI 3-DEFER ): an open-label , ran-domised controlled trial. :2199-2206.
11. Magdy AM, Demitry SR, Ali HH, Zaky M, Abd M, Hady E, Ghany MA. Stenting deferral in primary percutaneous coronary intervention : exploring benefits and suitable interval in heavy thrombus burden. Egypt Hear J. 2021.
12. Ren H, Zheng Y, Hu X, Yang Y, Zhang Y, Sun Y, Li B, Tian T, Wubuli D. High thrombus burden : a review of mechanisms and treatments. Int J Clin Exp Med. 2019;12:13068-13078.
13. Xiao Y, Fu X, Wang Y, Fan Y, Wu Y, Wang W, Zhang Q. Effects of different strategies on high thrombus burden in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary catheteriza-tion. 2019:555-563.
14. Tanboga IH, Topcu S, Aksakal E, Kalkan K, Se-vimli S, Acikel M. Determinants of Angiograph-ic Thrombus Burden in Patients With ST-Segment Elevation Myocardial Infarction. Clin Appl Thromb 20(7. 2014.
15. Scarparo P, Gameren M Van, Wilschut J, Dae-men J, Dekker WK Den. Impact of thrombus burden on long ‑ term clinical outcomes in pa-tients with either anterior or non ‑ anterior ST ‑ segment elevation myocardial infarction. J Thromb Thrombolysis. 2022:47-57.
16. Tabl MA, El-Rabbat KE, El-Keshk ES, Gharib GM. Journal of Cardiovascular Medicine and Deferred stent implantation in patients with ST segment elevation myocardial infarction with high thrombus burden. J Cardiovasc Med Cardiol. 2019;6:1-5.
17. Jolly SS, Cairns JA, Lavi S, Cantor WJ, Bernat I, Cheema AN, Moreno R, Kedev S, Stankovic G, Rao S V, Meeks B, Chowdhary S, Gao P, Sibbald M, Velianou JL, Mehta SR, Tsang M, Sheth T. Thrombus Aspiration in Patients With High Thrombus Burden in the TOTAL Trial. 2018;72.
18. Satılmış S, Durmuş G. Predictive accuracy of CHA 2 DS 2 -VASc score in determining the high thrombus burden in patients with non-ST-elevation myocardial infarction. Acta Cardiol. 2020;0:1-7.
19. Høfsten DE, Kelbæk H, Helqvist S, Kløvgaard L. The Third DANish Study of Optimal Acute Treatment of Patients with ST-segment Eleva-tion Myocardial Infarction : Ischemic postcon-ditioning or deferred stent implantation versus conventional primary angioplasty and complete revascularization versus treatmen. Am Heart J. 169:613-621.
20. Belle L, Motreff P, Mangin L, Rangé G, Marcaggi X, Marie A, et al. Comparison of Immediate With Delayed Stenting Using the Min imalist Immediate Mechanical Intervention Approach in The MIMI Study. Circ Cardiovasc Interv. 2016:1-9.
21. Kim JS, Lee HJ, Yu CW. Myocardial Infarction INNOVATION Study ( Impact of Immediate Stent Implantation Versus Deferred Stent Im-plantation on Infarct Size and Microvascular Perfusion in Patients With ST-. Circ Cardiovasc Interv. 2016:1-9.
22. Hu X, Yang X, Zhou X, Li2 X, Dong H, Zhou Y. Evaluating the Role of Deferred Stenting in ST-Segment Elevation Myocardial Infarction Pa-tients Presented with High Thrombus Burden : A Systematic Review and Meta-Analysis. Ann Cardiol Vasc Med Meddocs. 2021;4.
23. Isaaz K, Gerbay A. Correspondence Deferred stenting in acute ST elevation myocardial in-farction. Lancet. 2016;388:1371.
24. 2Kelbæk H, Engstrøm T, Ahtarovski KA, Lønborg J, Tilsted H, Raungaard B, Ravkilde J, Aaroe J, Eggert S. Deferred stent implantation in patients with ST-segment elevation myocar-dial infarction : a pilot study. EuroIntervention 2013;8:1126-1133. 2013.
25. Sakellariou XM, Katsanos GI, Efstathopoulos AP, Sfairopoulos DG, Stamatis K V, Pappas SD, Kolettis TM, Nikas DN. Should Deferred Stent-ing Still Be Considered in ST-Elevation Myo-cardial Infarction with High Thrombus Bur-den ? J Cardiovasc Dev Dis Commun. 2021:2-5.
26. Luo D, Yang X, Hu X, Liu J, Wang C, Ye J. Non-stenting strategy is not inferior to stent im-plantation in patients with acute ST-segment elevated myocardial infarction and high thrombus burden and intermediate stenotic culprit lesion. Ann Palliat Med. 2021.
27. Ahtarovski KA, Nepper-christensen L, Helqvist S, Vejlstrup N, Kyhl K, Schoos MM, Ghotbi A, Bertelsen L, Holmvang L, Pedersen F, Clem-mensen P, Backer O De. Myocardial Damage in Patients With Deferred Stenting After STEMI. J Am Coll Cardiol. 2017;69.
28. Publishers M, Cardiovascular G, Prevention HD, Cardiovascular G, Prevention HD. Evaluating the Role of Deferred Stenting in ST-Segment Elevation Myocardial Infarction Patients Presented with High Thrombus Burden : A Systematic Review and Meta-Analysis. 2021;4.
29. Çınar T, Şaylık F, Akbulut T, Asal S, Selçuk M, Çiçek V, Orhan AL. The association between whole blood viscosity and high thrombus bur-den in patients with non-ST elevation myocar-dial infarction. 2022:429-435.
30. Tanboga IH, Topcu S, Aksakal E, Kalkan K, Se-vimli S, Acikel M. Determinants of Angiograph-ic Thrombus Burden in Patients With ST-Segment Elevation Myocardial Infarction. 2014.
31. Hurst JW. Hurst’s The Heart. Vol 65. (Fuster V, Harrington RA, Narula J, Eapan ZJ, Vaishnava P, eds. ). ; 2017.
32. Svilaas T, Horst ICC Van Der, Zijlstra F. Throm-bus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study ( TAPAS )— Study design. Am Heart J. 2006:1-7.
33. O’Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, De Lemos JA, et al. 2013 ACCF/AHA guideline for the management of st-elevation myocardial infarction: A report of the American college of cardiology foundation/american heart association task force on practice guidelines. J Am Coll Cardiol. 2013;61:78-140.
34. Keeley EC, Boura JA, Grines CL. Primary angio-plasty versus intravenous thrombolytic thera-py for acute myocardial infarction : a quantita-tive review of 23 randomised trials. 2003;361.
35. Mahmoud AN, Elgendy AY, Mentias A, Elgendy IY. Deferred or immediate stent implantation for primary percutaneous coronary intervention : A meta-analysis of randomized trials. Wiley Period Inc. 2017:1-5.
36. Maria GL De, Oikonomou EK, Wolfrum M, Dm RPC, Mbbs APB. Role of deferred stenting in patients with ST elevation myocardial infarction treated with primary percutaneous coronary intervention : A systematic review and meta-analysis. Wiley J Interv Cardiol. 2017:1-10.
37. Harbaoui B, Courand P, Besnard C, Dauphin R, Cassar E, Lantelme P. Deferred vs immediate stenting in ST elevation myocardial infarction: Potential interest in selected patients. Presse Med. 2015;44:e331-e339.
38. Gonzalo N, Barlis P, Serruys PW, Garcia-Garcia HM, Onuma Y, Ligthart J. Incomplete Stent Ap-position and Delayed Tissue Coverage Are More Frequent in Drug-Eluting Stents Implanted During Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction Than in Drug-Eluting Stents Implanted for Stable /. 2009;2:445-452.
39. Trial H, Guo N, Maehara A, Mintz GS, He Y, Xu K, Wu X, Lansky AJ, Witzenbichler B, Guagliumi G, Brodie B, Kellett MA, Dressler O, Parise H, Mehran R, Stone GW. Acute and Late Stent Malapposition After Primary Intervention in Patients With Acute Myocardial Infarction An Intravascular Ultrasound Substudy of the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction. 2010:1077-1084.
40. Guyton AC, Hall JE. Guyton And Hall Textbook of Medical Physiology. Twelfth. (Schmitt W, Gruliow R, Laura Stingelin, eds. ). Philadelphia: Saunders Elsevier; 2011.
41. Pradhan A, Bhandari M, Vishwakarma P, Sethi R. Intervention Deferred Stenting for Heavy Thrombus Burden During Percutaneous Coro-nary Intervention for ST-Elevation MI Deferred Stenting for Heavy Thrombus Burden During PCI for STEMI Deferred Stenting Strategy : A Primer. 2021.
42. Li W, Wenhua H, Zhou Y, Guo Y. Immediate versus deferred percutaneous coronary inter-vention for patients with acute coronary syn-drome : A meta-analysis of randomized con-trolled trials. PLoS One. 2020:1-16.
43. Gaziano JM, Brotons C, Coppolecchia R, Cricelli C, Darius H, Gorelick PB, Howard G, Pearson TA, Rothwell PM, Ruilope LM, Tendera M, Tognoni G. Use of aspirin to reduce risk of ini-tial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a ran-domised, double-blind, placebo-controlled tri-al. Lancet. 2018;392:1036-1046.
44. Marquis-Gravel G, Jolicoeur EM. The Value of Deferred Stenting in Acute Myocardial Infarc-tion: Can Minimalist Immediate Mechanical In-tervention Do It All? Can J Cardiol. 2016;32:935-937.
45. Segment S-, Myocardial E, Yong CM, Tamis- JE. “ Goldilocks ” Approach to Deferred Stenting. 2022:1-4.