title: Novel use of a pericardium-covered stent graft to treat bulky coronary artery thrombus.
abstract: OBJECTIVE
  We studied the acute safety and feasibility of a pericardium-covered stent (PCS) in the obliteration of massive coronary thrombus.
  
  
  BACKGROUND
  Thrombus is frequently encountered in the setting of acute myocardial infarction, and conventional pharmacological and aspiration approaches are not always successful in dispersing or removing it, especially when it is very substantial.
  
  
  METHODS
  We treated nine patients (10 lesions) in the setting of an acute coronary syndrome characterized by the presence of substantial (TIMI grade 3-4) thrombus in a large caliber native coronary artery, persisting after conventional treatment, with percutaneous implantation of an equine PCS graft. Nine of 10 lesions were in large right coronary arteries.
  
  
  RESULTS
  Deployment was successful in nine of 10 lesions. In all nine cases, the filling defect was immediately eliminated and there was restoration or maintenance of TIMI grade 3 blood flow. There was one in-hospital stent thrombosis in a 56-year-old male, who had only received aspirin due to a coexistent stroke. This patient underwent successful repeat percutaneous intervention but died later of complications of the stroke. There were no 30-day events, and medium-term follow-up continues.
  
  
  CONCLUSIONS
  A PCS graft is a potentially useful device to treat massive thrombus burden in the setting of acute coronary syndrome. A larger study is warranted.
authors.affiliation: Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom. j.gunn@sheffield.ac.uk
authors.forename: Julian
authors.initials: J
authors.lastname: Gunn
authors.forename: Anjan
authors.initials: A
authors.lastname: Siotia
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Malkin
authors.forename: Javaid
authors.initials: J
authors.lastname: Iqbal
authors.forename: Tushar
authors.initials: T
authors.lastname: Raina
authors.forename: Allison C
authors.initials: AC
authors.lastname: Morton
mesh_terms: D054058:Acute Coronary Syndrome / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D000818:Animals; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D004739:England; D005240:Feasibility Studies; D005260:Female; D006736:Horses; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000637:transplantation*; D015607:Stents; D014183:Transplantation, Heterologous; D016896:Treatment Outcome