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How should I treat a massive thrombus embolisation in the left coronary artery during chronic total occlusion

Salvatore Geraci1, Alessio La Manna, Corrado Tamburino

  • 1Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|November 23, 2012
PubMed

Insights

A patient experienced massive thrombosis during percutaneous coronary intervention (PCI). Prompt aspiration and medication successfully cleared the clot, restoring blood flow and preventing myocardial damage.

Area of Science:

  • Cardiology
  • Interventional Cardiology

Background:

  • A 53-year-old male presented with unstable angina requiring percutaneous coronary intervention (PCI).
  • Severe stenosis of the first obtuse marginal artery and a chronic total occlusion (CTO) of the left circumflex artery were identified.

Observation:

  • During PCI, antegrade contrast injection caused a large clot to embolize into the left coronary artery, leading to massive thrombosis.
  • The patient became hemodynamically unstable with a damped pressure wave from the guiding catheter.

Findings:

  • Intravenous unfractionated heparin (UFH) and abciximab were administered, followed by successful clot aspiration.
  • Post-aspiration coronary angiography revealed no residual thrombi and restored TIMI-3 flow.
  • Cardiac magnetic resonance (CMR) confirmed no myocardial damage.

Implications:

  • This case highlights a rare complication during PCI involving massive coronary artery thrombosis.
  • Effective management with aspiration thrombectomy and pharmacotherapy can prevent adverse cardiac events.
  • Successful management underscores the importance of prompt recognition and intervention in embolic complications during PCI.
Abstract

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