A Coronary Artery Cast

Abstract

A 66-year-old woman with no significant previous medical history was admitted directly to our institution for primary percutaneous coronary intervention (PCI) with an inferolateral ST-segment elevation myocardial infarction. She had experienced onset of chest pain 10 hours prior to calling for an ambulance. Coronary angiography performed via the right radial artery demonstrated an occluded proximal right coronary artery (Fig. 1, A). Manual aspiration thrombectomy (Export catheter; Medtronic, MA) removed an extensive thrombus (Fig. 1, B) consistent with a coronary artery cast that had propagated from the site of occlusion into the bifurcation between the posterior descending and posterolateral arteries (Fig. 1, C, arrow). Following thrombus aspiration, flow was restored, and a single bare metal stent was deployed at the site of plaque rupture in the proximal vessel (Fig. 1, D) with an excellent final angiographic result and thrombolysis in myocardial infarction flow 3. Manual aspiration thrombectomy is a frequently used adjunctive therapy for patients with ST-segment elevation myocardial infarction and has been shown to improve microvascular perfusion and clinical outcomes. This case illustrates that where the thrombus burden is extensive, such as in large vessels or in late-presenting infarcts, the amount of thrombus removed with simple aspiration devices can be impressive. However, the evidence of benefit for routine thrombectomy is not conclusive, and although a meta-analysis reported a mor-