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Primary percutaneous coronary aspiration of thrombus from infarct related artery

Ayaz Hussain Shaikh1, Asad Pathan, Khursheed Hasan

  • 1Department of Cardiology, Tabba Heart Institute, Karachi. ahsdr1977@yahoo.com

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
|January 1, 2010
PubMed

Insights

Aspiration thrombectomy successfully cleared a blocked right coronary artery in a patient with ST elevation myocardial infarction (STEMI). Follow-up angiography showed restored blood flow, resolving the thrombus without the need for stenting.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • ST elevation myocardial infarction (STEMI) with right ventricular involvement presents a critical clinical scenario.
  • Thrombus burden in the right coronary artery (RCA) can lead to acute myocardial infarction.

Observation:

  • A 48-year-old male with hypertension and smoking history presented with acute inferoposterior STEMI and right ventricular infarction.
  • Diagnostic angiography revealed a total occlusion of the mid-RCA due to thrombus.

Findings:

  • Aspiration thrombectomy using Export Aspiration Catheter successfully removed thrombus from the RCA.
  • Thrombus migration to the distal right posterolateral branch (RPLB) was observed post-aspiration.
  • Glycoprotein (GP) IIb/IIIa inhibitors were initiated but discontinued due to upper gastrointestinal bleeding.

Implications:

  • Successful aspiration thrombectomy can restore coronary blood flow in STEMI cases with high thrombus burden.
  • Deferred stenting may be a viable strategy when no significant obstructive lesion is present post-thrombectomy.
  • Careful management of anticoagulation is crucial, especially in patients with bleeding risks.

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