The thrombus laden coronary artery--forget the fancy stuff, just aspirate it!
"No-reflow" is an important complication of percutaneous coronary intervention (PCI) in the setting of acute myocardial infarction and is associated with worse outcomes. Visible thrombus on the angiogram is a significant risk factor for "no-reflow". A variety of strategies have been employed to prevent this phenomenon including intracoronary vasodilators and distal protection systems. Randomized trials have not revealed any superiority of distal protection devices despite the theoretical rationale to their use. We describe a case of a thrombus-laden right coronary artery in which PCI would have likely resulted in significant "no-reflow". A simple aspiration catheter was used to significantly reduce the thrombus burden. Subsequent stenting was performed with no adverse events. This case illustrates the benefit of a less fancy approach to the thrombus-filled coronary artery - just aspirate it! Randomized trials are needed to test the role of simple aspiration prior to stenting in thrombus-laden coronary arteries.
Jafary
Fahim H
FH
Department of Medicine, Section of Cardiology, Aga Khan University Hospital, Karachi, Pakistan. jafary@pobox.com
Najaf
Syed M
SM
D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization / Q000379:methods*; D003131:Combined Modality Therapy; D017023:Coronary Angiography / Q000379:methods; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D013396:Suction / Q000379:methods; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology