A new technique to salvage myocardium following the failure of thrombus aspiration in acute myocardial infarction: a case report

作者：Si, Daoyuan^*; Liu, Guohui; Tong, Yaliang; Zhang, Cheng; He, Yuquan

来源：BMC Cardiovascular Disorders, 2018, 18(1): 228.

DOI：10.1186/s12872-018-0951-9

• Acute myocardial infarction
• Thromboembolism
• Aspiration thrombectomy
• Left main coronary artery

BackgroundThe failure of aspiration thrombectomy may negatively impact outcomes in patients with acute myocardial infarction (AMI), but the available options are limited.Case presentationA 41-year-old man with chest pain for 2h presented with ST-segment elevation myocardial infarction. Coronary angiography revealed a large filling defect extending from the distal left main (LM) coronary artery into the proximal left circumflex (LCX) coronary artery. The whole thrombus moved and occluded the proximal left anterior descending (LAD) artery, while the guidewire crossed the lesion. Dedicated manual aspiration thrombectomy (MAT) and balloon dilation failed to reduce thrombus burden. We considered thrombus extraction as impossible when it moved forward to occlude the middle LAD. To reduce infarct size, a new balloon-pushing technique was successfully performed to move the thrombus to the terminal LAD based on the actual condition of the LAD. The final angiogram demonstrated no stenosis in the LM artery and stent deployment was not performed. A 1-week follow-up coronary angiography revealed the complete resolution of thrombus and flow restoration in the left coronary artery. Intravascular ultrasound (IVUS) showed nonsignificant residual stenosis of the LM artery. No adverse events occurred during a 12-month follow-up period.ConclusionThis case suggests that the new balloon-pushing technique is a useful remedy if repeated MAT fails during AMI.

• 出版日期2018-12-10
• 单位吉林大学