Thrombectomy using aspiration catheter- An effective first line approach for resistant thrombi in patient of acute myocardial infarction

Acute myocardial infarction is caused by the rupture or erosion of an atherosclerotic plaque, initiating intra-luminal thrombosis resulting in partial or complete occlusion of a coronary artery. Primary percutaneous coronary intervention (PCI) is the preferred treatment and is effective in opening the infarct-related artery. These results can be further improved with thrombus aspiration which reduces stent thrombosis and improves myocardial blush. In acute presentation, there is a high load of thrombus in the infarct-related artery and stent placement in such a case increases the chances of the thrombus shifting both proximally and distally in the microvasculature. In such patient, deferred stenting along with the attempt of thrombus aspiration has the potential for complete thrombus removal with improvement in TIMI flow which eliminates the need of stenting. Here, we present an interesting case report pertaining to the feasibility of multiple thrombus aspiration attempts (>25) as first approach in young patient (Male/32 years/no co-morbidities) with late presentation of STEMI and a large resistant thrombus load on an angiogram. We also re-assessed the need of stenting after 5 days of thrombus aspiration attempt along with continued anticoagulation from the first contact with patient.