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A giant thrombus aspirated from a coronary artery
  1. T Miyamoto,
  2. T Sasaki,
  3. A Niwa
  1. miyamoto{at}

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A 72 year old woman was admitted to the emergency department with persistent chest pain. The ECG showed ST segment elevations in the inferior leads. She was diagnosed with acute myocardial infarction. Primary percutaneous coronary intervention (PCI) was performed. At first balloon angioplasty was applied. Coronary artery angiography revealed tandem defects in the right coronary artery after the procedure. We considered that the defect indicated a thrombus and attempted to aspirate it using the Rescue percutaneous thrombectomy system (Rescue PT, Boston Scientific Corp, Maple Grove, Minnesota, USA). The Rescue PT system consists of a flexible, dual lumen Monorail 4.5 French catheter and a collection bottle with a filter for separating solid bodies from blood that contains small pieces of thrombus and atheromatous plaque. A catheter and a vacuum assistance are used to break clots into small pieces that are collected into a bottle. This catheter was first inserted past the lesion and then pulled back slowly. A giant thrombus was withdrawn while attached to the tip of the aspiration catheter through the PCI guide catheter, without entering the usual aspiration hole of the Rescue catheter from the coronary artery.

Coronary artery angiography showed the defects decreased after aspiration therapy. Thus PCI was easily successful with adjunctive stenting. When there is a large thrombus in the coronary artery, it is very useful to aspirate it. We conclude that it is necessary to undergo this pullback procedure after aspiration so that blood containing thrombus in the PCI guide catheter is withdrawn fully, to avoid the thrombus remaining in the PCI guide catheter.

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Left panel: Coronary artery angiography showing the tandem defects (white arrows) in the right coronary artery before aspiration therapy. Middle panel: Undertaking aspiration therapy. The PCI guide wire reaches the distal branch in the coronary artery. The white arrow indicates the tip of the aspiration catheter. Right panel: After aspiration therapy, the defects nearly disappear.

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Aspirated giant thrombus, nearly 5.5 cm long.

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Haematoxylin and eosin staining of the aspirated giant thrombus. The material comprises mostly fibrin complexes and red and white blood cells.