Key result
Neurovascular stent-retriever thrombectomy restores flow and clears thrombus in refractory left main STEMI.
Why the study?
There are no guidelines for managing obstructive left main thrombi refractory to standard therapy, and limited data exist on neurovascular stent retrievers for intracoronary thrombus.
Case Report (n=1)
Neurovascular stent-retrievers may be a safe and effective bailout strategy for refractory intracoronary thrombus in acute coronary syndrome, including complex left main lesions.
May support neurovascular stent retriever as bailout for refractory left main thrombus; hypothesis-generating case report that leaves open prospective validation.
BACKGROUND: Left main coronary artery disease causing acute coronary syndrome is associated with high rates of mortality and morbidity. There are no guidelines to address the management of obstructive left main thrombi refractory to standard therapy, with limited data on neurovascular stent retrievers for treating intracoronary thrombus. CASE SUMMARY: A 41-year-old man presented with ST-segment elevation myocardial infarction due to a large distal left main thrombus with downstream embolization. Despite antithrombotic medical therapy and unsuccessful mechanical aspiration, definitive thrombus removal was achieved using the Medtronic Solitaire X with restoration of flow and no complications. DISCUSSION: Guidelines provide limited direction for refractory intracoronary thrombus. Emerging evidence supports neurovascular stent-retrievers as a feasible bailout strategy, though data remain sparse, particularly for left main interventions. TAKE-HOME MESSAGE: When conventional strategies fail, neurovascular stent-retriever thrombectomy may be a safe and effective adjunct for refractory coronary thrombus in acute coronary syndrome, including left main cases.
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Wangmang et al. (2026) conducted a case report in ST-segment elevation myocardial infarction (STEMI) of the left main coronary artery (n=1). Neurovascular stent-retriever thrombectomy (Medtronic Solitaire X) was evaluated on Definitive thrombus removal and restoration of flow. Neurovascular stent-retriever thrombectomy successfully achieved thrombus removal and restored flow without complications in a 41-year-old man with a refractory left main STEMI.
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