Contemporary therapy of intracoronary thrombus: laser and bioresorbable scaffold

Abstract

A 25-year-old diabetic, smoker presented with an acute anterior ST-segment elevation myocardial infarction. Immediate coronary angiography demonstrated an occluded left anterior descending artery (LAD) with large proximal thrombus burden. Simple aspiration catheter thrombectomy restored some antegrade flow but was unsuccessful in removing the thrombus (Fig. 1a). Photoablation using excimer laser coronary atherectomy (ELCA) was more effective in debulking the thrombus and restored TIMI 3 blood flow (Fig. 1c). Optical coherence tomography (OCT) clarified that the atherothrombotic material was localised without distal or proximal thin-cap fibroatheroma in the LAD (Fig. 1b). A bioresorbable vascular scaffold (BVS) was deployed and post dilated (Fig. 1d, e) with full expansion demonstrated with OCT (Fig. 1f, g) resulting in complete resolution of ST-segment elevation and symptoms. He made an excellent recovery and left hospital on day 3 post MI. He has subsequently returned to a full, active life. This case highlights both the effectiveness of ELCA in treating massive intracoronary thrombus and use of BVS to avoid long-term residual metallic stent in a young patient with coronary heart disease embarking on their revascularisation journey.