Key result
A novel balloon-pushing technique successfully moved an occlusive thrombus to the terminal left anterior descending artery after failed manual aspiration thrombectomy, resulting in complete thrombus resolution and no adverse events at 12 months.
Why the study?
Failure of aspiration thrombectomy can worsen outcomes in acute myocardial infarction, but available options remain limited.
Case Report (n=1)
A novel balloon-pushing technique may serve as a viable salvage strategy to minimize infarct size when manual aspiration thrombectomy fails during primary PCI for acute myocardial infarction.
May offer salvage when aspiration thrombectomy fails in primary PCI; case report leaves open need for prospective validation.
BACKGROUND: The failure of aspiration thrombectomy may negatively impact outcomes in patients with acute myocardial infarction (AMI), but the available options are limited. CASE PRESENTATION: A 41-year-old man with chest pain for 2 h 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. CONCLUSION: This case suggests that the new balloon-pushing technique is a useful remedy if repeated MAT fails during AMI.
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Si et al. (2018) conducted a case report in Acute myocardial infarction (n=1). Balloon-pushing technique was evaluated on Thrombus resolution and flow restoration. A novel balloon-pushing technique successfully moved an occlusive thrombus to the terminal left anterior descending artery after failed manual aspiration thrombectomy, resulting in complete thrombus resolution and no adverse events at 12 months.
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