Guidewire Retrieval Device as Bailout for Massive Coronary Thrombus in STEMI

Visual Summary. Guidewire Retrieval Device as Bailout for Massive Coronary Thrombus in STEMI (A) Angiography after first intervention showing multiple thrombi in RCA. (B) Repeat angiography 5 days later demonstrating RCA total occlusion with large thrombus burden (yellow arrow). (C) The Lawnest device in its fully expanded state. (D) Fluoroscopic image showing the system advanced to the mid-RCA. (E) Macroscopic appearance of thrombus captured by Lawnest device after retrieval. (F) Final angiography showing TIMI flow grade 3 without distal embolization. (G) Configuration of the integrated system. (H) Steps of coronary thrombectomy using the integrated system. RCA = right coronary artery; STEMI = ST-segment elevation myocardial infarction.

Figure 1. Initial and Repeat Angiographic Findings (A) Angiography after first intervention showing multiple thrombi in the RCA. (B) Repeat angiography 5 days later demonstrating RCA total occlusion with large thrombus burden (yellow arrow) and TIMI flow grade 0, consistent with TIMI thrombus grade 5. (C) Collateral circulation from the left circumflex artery (white arrow) providing Rentrop grade 2 flow to the distal RCA. RCA = right coronary artery.

Figure 2. Integrated System and Retrieval Maneuver (A) Schematic illustration of the fully expanded Lawnest device showing its key components: distal spring, retrieval basket, platinum-iridium marker, proximal spring, and nitinol core wire. (B) Configuration of the integrated system. The Lawnest device is connected to a 6-F Rebirth aspiration catheter via a hemostasis valve (Y-valve) attached to an aspiration syringe. This assembly is advanced over the guidewire through the guiding catheter, which is equipped with a separate hemostasis valve. (C) Image showing the Lawnest device positioned inside the Rebirth aspiration catheter. (D) Steps of coronary thrombectomy using the integrated system: (1) The assembly is advanced across the large thrombus under active aspiration. (2) While maintaining continuous negative pressure through the hemostasis valve, the aspiration catheter is retracted to deploy the Lawnest basket within the thrombus. (3) Continuous aspiration is maintained; the expanded Lawnest basket engages and captures the thrombus. (4) The Rebirth catheter is carefully readvanced to recapture the Lawnest device, and the entire system is withdrawn with continued aspiration to prevent…

Figure 3. OCT Assessment and Final Results (A) Distal RCA showing acceptable lumen area with small residual thrombus (white arrow). (B) Proximal RCA demonstrating thin-cap fibroatheroma (asterisk) with moderate residual thrombus (red arrow) and reduced lumen area. (C) Final angiography showing TIMI flow grade 3 without distal embolization. (D) Final OCT demonstrating optimal stent expansion with minimal thrombus prolapse and good apposition. OCT = optical coherence tomography; RCA = right coronary artery.

Figure 4. Coronary Thrombectomy With Lawnest Catcher (A) The Lawnest device in its fully expanded state. (B) Fluoroscopic image showing the system advanced to the mid-RCA. (C) Macroscopic appearance of thrombus captured by Lawnest device after retrieval. (D) Angiography after multiple retrieval passes showing significant thrombus reduction and restoration of TIMI flow grade 2 flow (downgraded from TIMI thrombus grade 5 to grade 3). RCA = right coronary artery.