Successful and Safe Retrieval of a Thrombus from the Lumen of a Guiding Catheter during Percutaneous Coronary Intervention

A 57-year-old man was hospitalized with chest pain of 1-h duration. Emergency coronary angiography revealed a total occlusion of a non-collateralized distal (segment 3) right coronary artery by a large thrombus. Multiple aspiration thrombectomies of the segment 3 lesion were performed, after which the thrombus migrated inside the guiding catheter. To prevent systemic embolization at the time of extraction, a double guiding procedure was performed to ensure that no thrombus was protruding from the tip of the catheter. The guiding catheter and a large red thrombus were ultimately safely extracted, while maintaining negative pressure in the catheter lumen with a syringe. The patient was discharged from the hospital on the 14th day free from chest pain. The histopathology of the aspirated thrombus was consistent with a coronary arterial embolization. This case indicates that, in patients with acute MI, aspiration thrombectomy performed for the prevention of thrombotic embolization can be safe and effective.