Thrombus Aspiration Alone: A Potential Strategy in ST Elevation Myocardial Infarction Intervention

Chong, Fei; Cox, Nicholas; Lim, Yeon Jung

doi:10.1016/j.hlc.2011.07.005

Cited by 2 publications

(2 citation statements)

References 6 publications

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“…As a consequence, additional balloon angioplasty or stent placement was not performed. Consistent with our case, several case series demonstrated that additional angioplasty and stenting might not be necessary if thrombectomy treatment results in the complete restoration of coronary flow without significant residual stenosis or signs of plaque disruption [ 7 , 8 ]. A recent 1-year follow-up report within the EROSION study demonstrated that a majority (92.5%) of patients with acute coronary syndrome caused by plaque erosion managed with aspirin and ticagrelor without stenting remained free of major adverse cardiovascular events for ≤1 year [ 9 ].…”

Section: Discussionsupporting

confidence: 86%

A new technique to salvage myocardium following the failure of thrombus aspiration in acute myocardial infarction: a case report

Liu

Tong

et al. 2018

BMC Cardiovasc Disord

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BackgroundThe failure of aspiration thrombectomy may negatively impact outcomes in patients with acute myocardial infarction (AMI), but the available options are limited.Case presentationA 41-year-old man with chest pain for 2 h presented with ST-segment elevation myocardial infarction. Coronary angiography revealed a large filling defect extending from the distal left main (LM) coronary artery into the proximal left circumflex (LCX) coronary artery. The whole thrombus moved and occluded the proximal left anterior descending (LAD) artery, while the guidewire crossed the lesion. Dedicated manual aspiration thrombectomy (MAT) and balloon dilation failed to reduce thrombus burden. We considered thrombus extraction as impossible when it moved forward to occlude the middle LAD. To reduce infarct size, a new balloon-pushing technique was successfully performed to move the thrombus to the terminal LAD based on the actual condition of the LAD. The final angiogram demonstrated no stenosis in the LM artery and stent deployment was not performed. A 1-week follow-up coronary angiography revealed the complete resolution of thrombus and flow restoration in the left coronary artery. Intravascular ultrasound (IVUS) showed nonsignificant residual stenosis of the LM artery. No adverse events occurred during a 12-month follow-up period.ConclusionThis case suggests that the new balloon-pushing technique is a useful remedy if repeated MAT fails during AMI.

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Section: Discussionsupporting

confidence: 86%

A new technique to salvage myocardium following the failure of thrombus aspiration in acute myocardial infarction: a case report

Liu

Tong

et al. 2018

BMC Cardiovasc Disord

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“…9 In our clinical experience and compatible with small sized series in the literature, successful management of selected primary PCI patients by using only thrombus aspiration catheter is possible although it is not based on a randomized trial. 10,11 Although authors reported good short-term survival, longterm follow-up of these series were absent. 10,12…”

Section: Discussionmentioning

confidence: 97%

Thrombus Entrapment in the Hemostasis Valve during Thrombus Aspiration: An Octogenarian with Inferior Myocardial Infarction and Complete Flow Restoration without Any Additional Angioplasty

et al. 2013

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plaque with superimposed thrombus is the basic pathophysiology of the myocardial infarction and distal embolization of thrombus during primary percutaneous coronary interventions (PCI) results in impaired myocardial perfusion and lower thrombolysis in myocaridal infarction (TIMI) flow grade. 1,2 Published reports demonstrate that adjunctive thrombus aspiration in ST-elevation myocardial infarction (STEMI) improves markers of myocardial reperfusion with limited improvement in survival. [3][4][5] Although it is known to be a quick and easily applicable procedure, some complications can be seen. We report an octogenarian with a trapped thrombus in guiding catheter during thrombus aspiration and complete flow restoration without any additional angioplasty or stent implantation. Case PresentationAn 80-year-old female presented with severe, ongoing chest pain for the last 1 hour. On physical examination, blood pressure was 100/60 mm Hg, and heart rate was 40/min. The electrocardiography showed third-degree atrioventricular block with ST-segment elevations in leads II, III, aVF, and reciprocal ST depression in leads V1-4. After administration of 600 mg clopidogrel, 300 mg aspirin, and 5,000 units of unfractionated heparin, the patient was immediately transferred to the cardiac catheterization laboratory. A temporary pacemaker lead was placed at right ventricle apex. By using a 6F JR4 guiding catheter, angiography revealed filling defect and total occlusion of distal right coronary artery (►Fig. 1a). After advancing of 0.014 inch floppy guidewire and passing through the lesion distally, thrombus aspiration was performed by using a StemiCath manual thrombus aspiration catheter (Minvasys, Gennevilliers, France). After few seconds, interruption of blood flow in the syringe was noticed and catheter was removed with ongoing suction. There was not any thrombus material in suction syringe or aspiration catheter and there was no spontaneous bleeding from hemostasis valve (y connector) tip. By negative aspiration of the guiding AbstractPublished reports demonstrate improved myocardial reperfusion with adjunctive thrombus aspiration in ST-elevation myocardial infarction (STEMI). However, implementation of this procedure without angioplasty or stent implantation is not clear. In this report, we present an octogenarian with inferior STEMI who was treated with thrombus aspiration alone. Another important feature of our case is trapped thrombus material in the guiding catheter during thrombus aspiration. Operators should avoid thrombus reinjection by controlling the system carefully during aspiration procedure.

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Thrombus Aspiration Alone: A Potential Strategy in ST Elevation Myocardial Infarction Intervention

Cited by 2 publications

References 6 publications

A new technique to salvage myocardium following the failure of thrombus aspiration in acute myocardial infarction: a case report

A new technique to salvage myocardium following the failure of thrombus aspiration in acute myocardial infarction: a case report

Thrombus Entrapment in the Hemostasis Valve during Thrombus Aspiration: An Octogenarian with Inferior Myocardial Infarction and Complete Flow Restoration without Any Additional Angioplasty

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