Mechanical thrombectomy can be applied to coronary thrombus retrieval in selected patients, a case study suggests.
A 40-year-old man presenting with ST-segment elevation myocardial infarction had a large thrombus in the mid and distal left main coronary artery with no obstructive stenosis. There were signs of distal embolization of some branches of the circumflex marginal artery as well.
Though clinicians initially gave him medical therapy, his chest pain returned and he was admitted to the cath lab for a novel interventional approach using the Solitaire stent retriever, Carlos E. Uribe, MD, of Hospital Pablo Tobon Uribe in Colombia, and colleagues reported in Catheterization and Cardiovascular Interventions.
After the thrombus was extracted, final angiography showed complete left main thrombus resolution and no post-procedural dissections or distal embolization. The patient had no periprocedural complications or chest pain and was discharged after 4 days.
“Using this strategy, we were able to achieve an excellent angiographic and clinical result,” the researchers concluded.
“This case, to our knowledge, is the first published report of the Solitaire stent [retriever device] being utilized for coronary mechanical thrombectomy,” they reported. “The use of the Solitaire stent was entertained due to [the] uniqueness of the patient’s presentation.”
Because the patient “had no risk factors for coronary artery disease and his arterial tree was free of significant obstructive disease, our belief was that the large left main thrombus was not likely secondary to a plaque rupture. Therefore, we were not compelled to proceed with balloon angioplasty and stent placement,” they explained.
The investigators did include some caveats when drawing their conclusions. For one, complications with stent retrieval techniques can include brain emboli. “Another potential limitation with this stent is that visibility is only possible at its radiopaque distal dot markers, making it somewhat cumbersome to precisely locate it within the thrombus,” Uribe and colleagues added.
Importantly, it is also unknown how the Solitaire device will perform in the setting of a complex atherosclerotic rupture plaque or a calcified lesion.
Patients with challenging anatomy may nonetheless benefit from mechanical thrombectomy as a bailout, the authors concluded, especially when standard balloon angioplasty and stenting are deemed “risk or potentially harmful.”
Uribe disclosed no relevant conflicts of interest.
Catheterization and Cardiovascular Interventions
Uribe CE, et al “Mechanical thrombectomy using the Solitaire stent in a left main coronary artery: a novel approach to coronary thrombus retrieval” Catheter Cardiovasc Interv 2016; DOI: 10.1002/ccd.26545.