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Published on: February 18, 2020
A novel treatment using a guide extension catheter and distal protection device for refractory coronary embolism:
Hirofumi Kusumoto1, Katsuyuki Hasegawa1, Kasumi Ishibuchi1
1Department of Cardiology, Higashi Takarazuka Satoh Hospital, Takarazuka, Hyogo 6650873, Japan.
Insights
A novel technique using a guide extension catheter and filter device effectively removes large thrombi in acute myocardial infarction patients, improving outcomes when aspiration alone fails.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- Large thrombus burden in acute myocardial infarction (AMI) correlates with poor patient outcomes.
- Current thrombus aspiration devices have limitations in completely removing extensive thrombi.
- Novel methods are needed to address challenging cases of massive coronary artery thrombosis.
Observation:
- A case of anterior ST-elevation myocardial infarction (STEMI) presented with severe left anterior descending artery occlusion.
- Standard thrombectomy with aspiration and guide catheter extension failed to fully recanalize the artery.
- A large, refractory thrombus was visualized within the occluded vessel.
Findings:
- A novel technique successfully retrieved a massive thrombus by trapping it between a guide extension catheter and a distal protection filter.
- Complete recanalization of the occluded artery was achieved without balloon angioplasty or stenting.
- The retrieved thrombus adhered significantly to the filter device axis.
Implications:
- This technique offers an effective solution for removing large, difficult coronary thrombi in STEMI patients.
- It presents a viable alternative when conventional aspiration methods are insufficient.
- Successful application can lead to improved procedural success and patient outcomes in complex thrombotic occlusions.
Background:
A large thrombus burden in patients with acute myocardial infarction is associated with worse outcomes. Although various methods of thrombus aspiration have been described, there is a potential limitation in the mechanism of eliminating a thrombus with only the use of an aspiration device. In this report, we present a novel method of retrieving massive thrombus using a guide extension catheter and a filter device.
Case Summary:
An 80-year-old man was diagnosed with anterior ST-elevation myocardial infarction (STEMI). Emergency coronary angiography revealed that the left anterior descending artery (LAD) showed an acute thrombotic occlusion in the mid-section. The percutaneous coronary intervention was performed to recanalize an occluded LAD. Although thrombectomy using an aspiration catheter and a guide catheter extension system was performed repeatedly, only a small amount of the thrombus was retrieved, and the LAD was still occluded. Therefore, we planned to remove the large thrombus burden by capturing the entire thrombus between the tip of the guide extension catheter and distal protection device, followed by pulling them out of the guide catheter together. A large amount of red thrombus, which adhered to the axis of the filter device, was successfully retrieved. The occluded LAD was successfully recanalized without balloon dilatation or stent implantation.
Discussion:
Although a variety of aspiration devices are available, removal of large coronary artery thrombi with the use of an aspiration catheter alone can at times prove difficult. To solve this problem, we developed a novel technique for retrieving large thrombi. This method is effective in removing refractory thrombi for the treatment of STEMI patients.
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