The role of the guiding catheter to increas the efficiency of thrombus aspiration
█ Case report
Kákonyi Kornél, Katona András, Ungi Imre1
1Szegedi Tudományegyetem, Általános Orvostudományi Kar, Belgyógyászati Klinika,
Invazív Kardiológiai Részleg, Szeged
Dr. Kákonyi Kornél, SZTE Szent-Györgyi Albert Klinikai Központ, Belgyógyászati Klinika, Invazív Kardiológiai Részleg,
6725 Szeged, Semmelweis u. 8. E-mail: email@example.com
The role of routine thrombus aspiration during the management of ST-segment-elevation myocardial infarction is debatable. According to recent randomized controlled clinical trials (TASTE [Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia] and TOTAL [Trial of Routine Aspiration Thrombectomy With PCI Versus PCI Alone in Patients With STEMI]) the routine use is not recommended. Nevertheless, in case of large, visible thrombus aspiration is an important option for interventional cardiologists during primary PCI.
64-year-old male patient was diagnosed with inferior STEMI. Coronary angiography revealed stent thrombosis of the right coronary artery posterolateral branch. We aspirated several times with 6F aspiration catheter but a huge thrombus near the crux was not being retractable. We performed deep intubation with 6F guiding catheter and aspirated the thrombus. Culotte PCI was done in the bifurcation. Angiographic result was good, antegrade TIMI 3 flow.
29 year-old male patient was diagnosed with inferior STEMI. Coronary angiography revealed occlusion of distal segment of the right coronary artery. We aspirated several times with 6F aspiration catheter but huge thrombus residuum was not aspirateable. The 6F guiding catheter was introduced into the distal segment of the right coronary artery and aspirated the thrombus. Control coronary angiography verified no significant coronary artery stenosis and TIMI 3 flow therefore stent implantation was not performed.
Although thrombus aspiration with a guiding catheter is not harmless technique, because of the risk of injury of the proximal segment of the vessel, but doing with a great routine it is more effective than aspiration with dedicated catheters, because of bigger inner diameter.