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Fibrin thrombus causing myocardial infarction in a patient with patent coronary arteries
  1. J-Y Wang,
  2. L-C Lin

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A 47 year old woman, without coronary artery disease risk factors, first noted severe chest tightness as she was hurrying to catch the subway (underground). Acute inferior wall ST segment elevation myocardial infarction was diagnosed.

Emergent coronary angiography revealed one vessel disease. The right coronary artery (RCA), the infarct related artery, was occluded with thrombus containing lesions over the middle portion (panel A, arrow). An Export aspiration catheter was advanced into the RCA for thrombosuction. However, poor coronary flow was still noted due to ineffectiveness of removing large visible thrombi in the RCA. Balloon angioplasty was performed later without success, too. Since thrombosuction was considered to be able to relieve the thrombus burden rapidly, the guiding catheter was deeply advanced to the lesion (panel B) using the balloon catheter as an anchor. A large thrombus was aspirated. The aspirated thrombus, size 10 × 5× 3 mm, white (panel D) was found to match the filling defect on the angiography. The final angiography revealed an excellent result (panel C) with a TIMI 3 flow. The histopathological examination showed that the aspirated thrombus was composed of fibrin material and few blood cells (panel E). The patient’s hospital course was smooth and she was discharged four days later.

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