Intravascular ultrasound‐guided management of large thrombus burden in an aneurysmal coronary artery in a young male

Abstract

Management of acute thrombotic occlusion of coronary artery aneurysms is challenging with a lack of randomized trial evidence. We report an unusual case of a 30-year-old Indian Australian male who presented with an extensive anterior STEMI because of very large thrombus burden in a dilated proximal left anterior descending artery. A relatively conservative treatment approach comprising emergency aspiration thrombectomy and ongoing infusion of glycoprotein IIb/IIIa inhibitor, guided by surveillant inpatient angiography and intravascular ultrasound, helped achieve a satisfactory outcome in a complex setting in which percutaneous coronary angioplasty and stenting were not desirable. © 2014 Wiley Periodicals, Inc.

Dual antiplatelet agents and Rivaroxaban for massive intracoronary thrombus in STEMI

“…When extensive thrombi are seen in aneurysmal coronary arteries, they have been variously managed. They have been treated with intracoronary thrombolysis followed by heparin and warfarin 9 , aspiration thrombectomy followed by prolonged intravenous infusion of a glycoprotein IIb/IIIa inhibitor 10 , guide catheter aspiration together with the use of distal protection devices, withdrawal of a distal filter vascular protection device together with adjunct glycoprotein IIb/IIIa inhibitor 11 . Recently in patients with large acute anterior wall STEMI, aspiration thrombectomy was not found to significantly reduce infarct size 12 .…”