A case of intracoronary protruded thrombus caused after bailout stenting for side branch occlusion

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Percutaneous coronary intervention (PCI) is a common procedure for treating coronary artery disease.
• Bifurcation lesions present unique challenges in PCI due to complex anatomy and increased risk of complications.
• Side branch management during PCI is critical for procedural success and long-term outcomes.

Observation:

• A 69-year-old woman with severe coronary artery stenosis underwent PCI at a left anterior descending artery-first diagonal branch bifurcation.
• After stenting the main vessel and dilating the side branch, dissection and hematoma led to side branch occlusion.
• Subsequent bailout stenting in the diagonal branch resulted in thrombus projection into the left anterior descending artery.

Findings:

• The case demonstrates a rare complication of PCI: thrombus projection from a stented side branch into the main coronary artery.
• Despite aspiration, ballooning, and thrombolytic therapy, distal embolism occurred, highlighting the complexity of managing this complication.
• The initial dissection and hematoma formation at the ostium of the diagonal branch likely contributed to the thrombus projection.

Implications:

• This case underscores the importance of meticulous technique and careful consideration of potential complications during bifurcation PCI.
• It highlights the need for vigilance in recognizing and managing rare events like thrombus projection to prevent adverse outcomes.
• Further research into strategies for preventing and treating thrombus projection during complex PCI may be warranted.