title: How should I treat a massive thrombus embolisation in the left coronary artery during chronic total occlusion revascularisation?
abstract: BACKGROUND
  A 53-year-old man symptomatic for unstable angina, underwent PCI for a severe stenosis of the first obtuse marginal and a CTO of the left circumflex arteries.
  
  
  METHODS
  Physical examination, myocardial necrosis markers, ECG, transthoracic echocardiography, exercise ECG test, bilateral coronary angiography, cardiac magnetic resonance.
  
  
  METHODS
  During PCI, antegrade contrast injection displaced a large clot from the guiding catheter into the left coronary artery causing massive thrombosis. The patient became haemodynamically unstable. The pressure wave from the guiding catheter was damped.
  
  
  RESULTS
  Intravenous UFH and abciximab followed by aspiration from the guiding catheter, and then through an aspiration catheter, until clear blood came out and pressure wave was normalised. Subsequent left coronary angiography showed no residual thrombi with TIMI-3 flow. Afterwards, a CMR scan showed no myocardial damage.
authors.affiliation: Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Geraci
authors.forename: Alessio
authors.initials: A
authors.lastname: La Manna
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
mesh_terms: D000077284:Abciximab; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D000925:Anticoagulants / Q000008:administration & dosage; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D010808:Physical Examination; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013396:Suction; D017131:Thrombectomy / Q000379:methods*; D013923:Thromboembolism / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D015415:Biomarkers; D007140:Immunoglobulin Fab Fragments; D006493:Heparin; D000077284:Abciximab