Novel Approach Using Aspiration Thrombectomy for Aortic Root Thrombus After LVAD Implantation

Figures

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  Figure 1. Findings on Coronary Angiography Coronary angiography of the (A) right coronary system and (B) left coronary system. There is absence of flow within the left main coronary artery. (C) An aortogram demonstrated a significant filling defect within the left coronary cusp (arrow).

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  Figure 2. TEE of the Aortic Root With Evidence of a Large Thrombus The thrombus was seen within the left coronary cusp and extended into the LMCA (arrows). LMCA = left main coronary artery; TEE = transesophageal echocardiography.

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  Figure 3. Aspiration of the Thrombus With the Penumbra Device The Penumbra Lightning Flash 2.0 computer-assisted vacuum thrombectomy catheter (arrow) was advanced to the aortic root, and aspiration of the thrombus was performed within the left coronary cusp.

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  Figure 4. Follow-Up Angiography and Intraprocedural TEE (A) Follow-up angiogram revealed persistent large thrombus burden within the LMCA, extending in the left anterior descending artery. (B) Intraprocedural TEE demonstrated successful resolution of the thrombus within the aortic root; however, there was remaining thrombus in the ostium of the LMCA (arrows). LMCA = left main coronary artery; TEE = transesophageal echocardiography.

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  Figure 5. Use of Penumbra Bolt 7 Device in Response to the Persistent Thrombus The Penumbra Bolt 7 thrombectomy device was connected to an EBU 3.5 guide catheter, and a GuideLiner guide extender was then advanced beyond the catheter into the LMCA, allowing for controlled aspiration and effective extension within the vessel. LMCA = left main coronary artery.

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  Figure 6. Final Coronary Angiography Demonstrating Restoration of TIMI Flow Grade 3 Within the Left Coronary System and Resolution of Thrombus Burden

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  Figure 7. Final TEE Demonstrating Resolution of Thrombus Burden Within the Ostium of the LMCA (Arrow) LMCA = left main coronary artery; TEE = transesophageal echocardiography.

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  Figure 8. Retrieval of the Sentinel Device (A) Retrieval of the Sentinel cerebral protection device showing successful capture of small, fragmented clot material during the aspiration procedure. (B) The Penumbra canister demonstrating the clot burden that was removed. (C) The gross specimen of thrombus that was removed during the procedure.