{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T05:09:08Z","timestamp":1781154548036,"version":"3.54.1"},"reference-count":80,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>In ST-Elevation Myocardial Infarction (STEMI), Primary Percutaneous Coronary Intervention (PPCI) is the preferred treatment. However, High Thrombus Burden (HTB), defined by extensive thrombus in the Infarct-Related Artery (IRA), particularly with \u201ccut-off\u201d occlusion patterns and large vessel diameter (&amp;gt;3.5\u2005mm), presents a major challenge. Despite the use of effective anticoagulation, glycoprotein IIb\/IIIa inhibitors, and Dual Antiplatelet Therapy (DAPT), HTB remains a significant obstacle. It is associated with complications such as no\/slow reflow and distal embolization, leading to adverse cardiovascular outcomes. Accurate assessment using angiographic features and MI thrombus grading is essential before choosing a therapeutic strategy. Management options include mechanical thrombectomy, aspiration, parenteral\/oral antiplatelets, intracoronary thrombolytics, and stenting approaches like direct stenting. Success depends on tailored, scenario-specific application of these therapies. This review highlights current strategies to manage HTB during PPCI.<\/jats:p>","DOI":"10.3389\/fcvm.2025.1610917","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T07:29:43Z","timestamp":1770622183000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Approach to large thrombus burden in ST-elevation myocardial infarction"],"prefix":"10.3389","volume":"12","author":[{"given":"Rohit","family":"Mody","sequence":"first","affiliation":[{"name":"Department of Cardiology, Mody Harvard Cardiac Institute & Research Centre, Krishna Super Specialty Hospital","place":["Bathinda, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debabrata","family":"Dash","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Aster Hospital","place":["Dubai, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhavya","family":"Mody","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Resident Doctor, Trinity Health Hospital","place":["Livonia, MI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umanshi","family":"Dash","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mody Harvard Cardiac Institute & Research Centre, Krishna Super Specialty Hospital","place":["Bathinda, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajeev","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Spectrum Medical Center and Burjeel Royal Hospital","place":["Al Ain, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1016\/j.jacc.2007.04.059","article-title":"Angiographic stent thrombosis after routine use of drug-eluting stents in ST-segment elevation myocardial infarction: the importance of thrombus burden","volume":"50","author":"Sianos","year":"2007","journal-title":"J Am Coll Cardiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/S0140-6736(03)12113-7","article-title":"Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials","volume":"361","author":"Keeley","year":"2003","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1093\/eurheartj\/ehi810","article-title":"Does time matter? 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