In these figures we illustrate the successful removal of visible occlusive thrombus from the right coronary artery with a new helical thrombectomy device (X-Sizer).

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A 40 year old male smoker with known but untreated hyperlipidaemia was admitted with an acute inferior myocardial infarction. Despite treatment with thrombolysis within two hours of onset of his symptoms he continued to experience chest pain and ECG ST segment elevation failed to improve. He was transferred to our hospital and angiography at approximately three hours post-thrombolysis showed a total acute occlusion of the culprit vessel. Despite crossing the lesion with a guide wire there was no distal flow. The X-Sizer was advanced over the wire and activated with a hand held, battery operated source to achieve restoration of TIMI III flow. Histology of the excised fragments showed fresh acellular thrombus. The procedure was completed with the deployment of two stents and no acute complication. No glycoprotein IIb/IIIa antagonist was used.

Thrombosis in the background of plaque rupture or fissure is increasingly recognised to be the pivotal event in the pathogenesis of acute coronary syndromes, not only in the acute myocardial infarction but also in the syndrome of unstable angina/non-Q wave myocardial infarction. While the outcome after percutaneous intervention is normally good, the presence of visible thrombus is associated with a worse outcome and more complications. Until recently, there has been no safe and effective means of removing thrombus mechanically before balloon angioplasty and stenting.

This is a very promising new device for a common clinical problem.