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Embolization of a Large Intracoronary Thrombus During ST-Segment Elevation Myocardial Infarction

Nathaniel R Smilowitz1, Claudia Serrano-Gomez

  • 1New York University School of Medicine, 550 1st Avenue, HCC-14th Floor, New York, NY 10016 USA. Nathaniel.Smilowitz@nyumc.org.

The Journal of Invasive Cardiology
|October 5, 2017
PubMed

Insights

Aspiration thrombectomy successfully removed intact thrombus, resolving bradycardia and hypotension. Balloon angioplasty addressed proximal right coronary artery in-stent restenosis, restoring optimal blood flow.

Area of Science:

  • Cardiovascular Interventions
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • In-stent restenosis (ISR) of the right coronary artery (RCA) poses a significant challenge in cardiovascular care.
  • Intact thrombus retrieval is crucial for managing acute cardiovascular events.

Observation:

  • A 69-year-old woman presented with symptoms requiring intervention.
  • Bradycardia and hypotension were observed during the procedure.
  • Proximal RCA in-stent restenosis was identified as the target lesion.

Findings:

  • Aspiration thrombectomy was successfully employed to retrieve an intact thrombus.
  • The patient's bradycardia and hypotension resolved promptly following thrombectomy.
  • Balloon angioplasty at the site of proximal RCA ISR resulted in improved angiographic appearance.
  • Thrombolysis In Myocardial Infarction (TIMI) 3 flow was achieved in the major branches post-angioplasty.

Implications:

  • Aspiration thrombectomy is an effective modality for intact thrombus removal in complex coronary interventions.
  • Successful angioplasty for RCA ISR can restore adequate coronary perfusion.
  • This case highlights the combined efficacy of thrombectomy and angioplasty in managing ISR with acute complications.

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