Manual Coronary Thrombectomy in Primary PCI: What a Satisfaction it is Sometimes to Look Into the Catheter

J INVASIVE CARDIOL 2022;34(1):E71-E72.

Key words: primary PCI, STEMI, thrombus

An 89-year-old woman was referred to our cath lab for a primary percutaneous coronary intervention (pPCI) following electrocardiographic evidence of inferior ST-segment elevation myocardial infarction. A coronary angiography revealed single-vessel disease with complete occlusion of the right coronary artery (Figure 1). After crossing the occlusion with a guidewire, we proceeded with manual thrombectomy using the Eliminate Aspiration Catheter (Terumo Europe). We slowly advanced through the occlusion with the thrombus aspirator catheter a few times, until we noticed a sudden interruption of blood flow in the syringe connected to the catheter. We removed the device to check and surprisingly a huge red thrombus remained enveloped between the tip of the suction catheter and the Y-connector of the guiding catheter. We gently disconnected the Y-connector and removed the thrombus en bloc by performing a mild saline wash of the suction catheter. The thrombus, placed lengthwise on sterile gauze, was about 6 cm long (Figure 2). To our knowledge, this is the longest coronary thrombus ever reported to be removed in its entirety. We successfully completed the pPCI with the implantation of a 3 x 26 mm drug-eluting stent (Figure 3).

Hematoxylin and eosin staining of the aspirated material revealed a thrombus in the early lytic phase, composed of fibrin, red blood cells, and neutrophils (Figure 4).

From the ¹Interventional Cardiology Unit, “Santa Maria” University Hospital, Terni, Italy; ²Department of Radiology, Oncology and Pathology, "Sapienza" Università di Roma, Policlinico Umberto I, Rome, Italy.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted August 18, 2021.

The authors report patient consent for the images used herein.

Address for correspondence: Alessio Arrivi, MD, PhD, Santa Maria University Hospital, Via Tristano di Joannuccio 1, 05100, Terni, Italy. Email: alessio.arrivi@libero.it

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