Complete aspiration of thrombi from an occluded coronary artery

A 43 year-old male heavy smoker with no specific medical history was brought to our hospital with sudden chest pain. An ECG revealed ST segment elevation in precordial leads. An echocardiogram detected severe hypokinesis in the anterior wall of the left ventricle. After intravenous administration of heparin (10 000 IU), the patient underwent coronary angiography, which demonstrated total occlusion of the dilated left anterior descending coronary artery (panel A, video A) (to view video A visit the Heart website—http://www.heartjnl.com/supplemental). A 0.014 inch guidewire easily crossed the occlusion. Thrombectomy was attempted with the Thrombuster aspiration catheter (Kaneka Medical, Tokyo, Japan). Intraluminal coronary artery blood around the occlusion site was collected through several aspirations. A number of red cylindrical thrombi were caught by the filter (panel B). Histological examination of the aspirates revealed that the thrombi were exclusively composed of fibrin and red blood cells with a few haematopoietic cells (panel D, bar 5 mm). No atheromatous plaque was detected. After the thrombectomy, angiography revealed no haziness of the left anterior descending coronary artery and good blood flow (TIMI grade 3; panel C, video B) (to view video B visit the Heart website—http://www.heartjnl.com/supplemental). The patient recovered well on aspirin, ticlopidine, and carvedilol. The follow up angiography showed no organic lesion in the coronary arteries.