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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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[Clinical case of using manual thrombus aspiration during percutaneous coronary intervention in a patient with

V M Mironov, A S Tereshchenko, E V Merkulov

    Vestnik Rentgenologii I Radiologii
    |April 14, 2015
    PubMed

    Insights

    This case study highlights a patient with ST-segment elevation acute coronary syndrome, likely caused by a thromboembolic event rather than coronary artery disease. Effective intervention involved thrombus aspiration, revealing no significant stenoses.

    Area of Science:

    • Cardiology
    • Interventional Cardiology
    • Thrombosis

    Background:

    • ST-segment elevation acute coronary syndrome (STEMI) requires prompt reperfusion therapy.
    • Thromboembolic events can mimic or cause myocardial infarction.
    • Persistent atrial fibrillation increases the risk of embolic stroke and systemic embolism.

    Observation:

    • A patient presented with STEMI despite ineffective prehospital thrombolysis.
    • Percutaneous coronary intervention with thrombus aspiration was performed 3.5 hours after symptom onset.
    • Angiography revealed no significant coronary artery stenoses after thrombus removal.

    Findings:

    • The patient had a history of persistent atrial fibrillation and transient ischemic attacks.
    • The absence of coronary stenosis post-intervention suggests a non-atherosclerotic, likely thromboembolic, origin of the myocardial infarction.
    • Successful thrombus aspiration was achieved, improving the angiographic appearance.

    Implications:

    • This case underscores the importance of considering thromboembolic causes in myocardial infarction, especially in patients with atrial fibrillation.
    • Thrombus aspiration can be a crucial intervention when coronary artery stenosis is not the primary pathology.
    • Further investigation into the embolic source is warranted for long-term management.

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