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Guidewire Retrieval Device as Bailout for Massive Coronary Thrombus in STEMI
Yan Wu1, Xizhan He2, Wenyuan Li1
1Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Background:
Patients with ST-segment elevation myocardial infarction (STEMI) and massive thrombus burden (TIMI flow grade 5) remain challenging to manage. Conventional aspiration thrombectomy often fails to achieve adequate thrombus reduction.
Case Summary:
A 52-year-old man presented with recurrent right coronary artery occlusion 5 days after initial intervention for acute inferior STEMI. After failed conventional aspiration, a guidewire retrieval device (Lawnest) integrated with an aspiration catheter was employed as a bailout. Optical coherence tomography confirmed significant thrombus reduction from TIMI flow grade 5 to grade 3, enabling successful drug-eluting stent implantation.
Discussion:
This case demonstrates a novel bailout technique using a coronary-specific guidewire retrieval device integrated with aspiration catheter via a hemostasis valve for refractory massive thrombus when conventional thrombectomy fails.
Take-Home Message:
Coronary-specific guidewire retrieval devices can serve as bailout techniques for refractory massive thrombus when integrated with aspiration catheters to minimize distal embolization risk.
