Key result
Manual thrombus aspiration alone without stenting resolves thrombus and improves LVEF by ~10 points at 3 years.
Why the study?
Acute thrombotic occlusion of the left main and proximal LAD arteries is an uncommon, life-threatening cause of STEMI. Although routine thrombus aspiration is not recommended during primary PCI, it may have a role in selected patients with a heavy thrombus burden.
Case Report (n=1)
No
In carefully selected patients with thrombus-rich left main-LAD occlusion and minimal underlying atherosclerosis confirmed by IVUS, manual thrombus aspiration alone with medical therapy can achieve durable three-year angiographic resolution and ventricular recovery without stenting.
Answers are grounded in this paper and cite their sources.
May support aspiration-only strategy in select IVUS-confirmed cases; leaves open generalizability without prospective trials.
Introduction: Acute thrombotic occlusion involving the left main (LM) coronary artery and the proximal left anterior descending (LAD) artery is an uncommon but life-threatening cause of ST-elevation myocardial infarction (STEMI), jeopardizing a large territory of myocardium and carrying a high risk of early mortality. Although routine thrombus aspiration is not recommended for all patients undergoing primary percutaneous coronary intervention (PCI), it may have a role in selected patients with a heavy thrombus burden. Case presentation: We describe a 57-year-old woman with diabetes mellitus and hypertension who presented with an acute anterior STEMI. Coronary angiography demonstrated a large thrombus occluding the distal LM and extending into the proximal LAD. Manual thrombus aspiration alone restored normal flow without stent implantation. Intravascular ultrasound (IVUS) confirmed complete thrombus resolution with minimal underlying plaque and preserved lumen dimensions. At three-year follow-up, repeat angiography showed normal coronary arteries, and echocardiography demonstrated recovery of left ventricular ejection fraction (EF) from 40% to 50% with normalization of wall motion. Conclusion: In carefully selected patients with thrombus-rich LM–LAD occlusion and minimal underlying atherosclerosis, thrombus aspiration alone may restore coronary flow and avoid stenting, with durable angiographic and ventricular recovery on long-term follow-up. IVUS provides essential information to guide this strategy.
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Alqahtani et al. (2026) conducted a case report in Acute anterior ST-elevation myocardial infarction (STEMI) with distal left main and proximal left anterior descending artery thrombotic occlusion (n=1). Manual thrombus aspiration alone guided by intravascular ultrasound (IVUS) plus guideline-directed medical therapy was evaluated on Angiographic resolution and left ventricular ejection fraction (LVEF) recovery at 3 years. Manual thrombus aspiration alone without stenting achieved complete angiographic thrombus resolution and improved LVEF from 40% to 50% at 3-year follow-up.
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