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A 68 year old man without previous history of cardiac disease was admitted with syncope. The ECG showed ST segment elevation in leads II, III, and aVF, as well as advanced atrioventricular block. The right coronary artery angiogram showed a luminal filling defect suggestive of thrombus just proximal to an occlusion (panel A). It was decided to perform percutaneous coronary intervention for this lesion, using of a distal protection device and aspiration catheter. Monitoring of the blood pressure at the tip of a 7 French sized guide catheter suddenly became impossible after an aspiration catheter was pulled out. The guide catheter was found to be displaced from the ostium of the right coronary artery. We assumed that the occlusion had occurred at the tip of the guide catheter, therefore we tried to remove the whole system from the body. Fortunately, it was pulled out with negative pressure on the entire guide catheter and a massive thrombus was also aspirated (panels B and C). After that, we reinserted the catheter and performed coronary intervention. Finally, a stent was implanted at the culprit stenosis at the middle of the right coronary artery. We confirmed that TIMI III coronary blood flow was restored without residual intracoronary thrombi.
Because the aspiration catheter was pulled out through the guide catheter under negative pressure, the guide catheter itself may have acted as an effective aspiration system.