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
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.