Use of the Heartrail ST01 catheter for optimized aspiration thrombectomy in a patient with ST-segment elevation myocardial infarction with a large intracoronary thrombus

摘要

A 91-year-old woman presented with ST-segment elevation myocardial infarction (STEMI) after taking a meal. The emergent coronary angiography demonstrated acute proximal occlusion of the right coronary artery (RCA) (Figure 1 A). Initial aspiration thrombectomy (AT) with a Thrombuster II (Kaneka Medical) thrombus aspiration catheter (extraction area (EA) 0.95 mm2) recovered TIMI III flow. However, post-aspiration angiography demonstrated severe residual thrombus burden (Figure 1 B). Because of its large suction area, a guide extension mother-and-child catheter, Heartrail ST01 5 Fr (cross section area, CSA 1.77 mm2, Terumo Medical) catheter was positioned proximal to the site of the occlusion (Figure 1 C). Aspiration was performed with suction pressure generated by a 30 ml vacuum syringe and a larger and long embolus was sucked out (Figure 1 E), resulting in evident reduction of thrombus burden (Figure 1 D) and it was completed with a 3.5 × 30 mm zotarolimus-eluting stent (Endeavor, Medtronic) implantation. Histological examination showed thrombus with abundant infiltration of neutrophil (Figure 1 F). Furthermore, the patient received 100 mg of aspirin once daily and 90 mg of ticagrelor twice daily for 2 weeks, which was replaced by 100 mg of aspirin plus 75 mg of clopidogrel once daily with an 8-month follow-up to date and the patient has not suffered cardiovascular or bleeding events.