Author + information
- Received September 27, 2016
- Accepted October 6, 2016
- Published online February 6, 2017.
- aDivision of Cardiology, University of Miami Miller School of Medicine, Miami, Florida
- bDepartment of Neurology & Neurosurgery, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
- cDivision of Cardiology, Jackson Memorial Hospital, Miami, Florida
- ↵∗Address for correspondence:
Dr. Dileep R. Yavagal, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Clinical Research Building Suite 1139, Miami, Florida 33136.
The left main coronary artery (LMCA) as an infract-related artery in acute ST-segment elevation myocardial infarction (STEMI) is rare, with rates ranging from 0.8% to 1.7% of all STEMI cases (1). Aspiration thrombectomy and AngioJet (Medrad Interventional/Possis, Minneapolis, Minnesota) have been commonly used for major thrombus burden. Stent-based mechanical thrombectomy has become the frontline strategy in the management of acute ischemic stroke (2). However, there is no data about its use in the coronary artery. We report the first experience with stent-based mechanical thrombectomy in a patient presenting with STEMI due to LMCA thrombus. Complete recanalization, defined as Thrombolysis In Myocardial Infarction (TIMI) flow grade 3, was achieved in 90 min after femoral access was gained.
A 33-year-old man with heroin, cocaine, and tobacco abuse presented with STEMI and cardiogenic shock. Coronary angiography revealed that the culprit lesion was a subtotal LMCA occlusion, with TIMI trial flow grade 1 in the left anterior descending artery associated with a filling defect compatible with an aggressive thrombotic process (TIMI thrombus scale classification 3) (Figure 1). The Impella CP device (ABIOMED Inc., Danvers, Massachusetts) was implanted for left ventricular support via the left femoral artery for cardiogenic shock. Aspiration thrombectomy was unsuccessful. AngioJet was not used due to proximity to aorta, risk of peripheral embolism including stroke, and aortic dissection. Finally, thrombectomy was attempted with 4 × 20 mm Solitaire FR revascularization device (Medtronic, Minneapolis, Minnesota) in LMCA and LAD, but was unsuccessful. A second attempt was made with 6 × 30 mm Solitaire FR device (Medtronic) (Figure 2), resulting in TIMI flow grade 3 and complete thrombus disappearance (Figure 3).
This case illustrates the potential application of stent-based mechanical thrombectomy in the coronary artery when aspiration thrombectomy or AngioJet is unsuccessful.
Dr. Yavagal has served as a consultant to and received modest fees from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 27, 2016.
- Accepted October 6, 2016.
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