• Stent Retriever Extracts Man's Coronary Clot Manual thrombectomy feasible for 'bailout' case report says

    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.”

    Disclosure

    Uribe disclosed no relevant conflicts of interest.

    Source:

    Catheterization and Cardiovascular Interventions

    http://onlinelibrary.wiley.com/doi/10.1002/ccd.26545/abstract

    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.

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