How should I treat a 'swinging' left main thrombosis complicating coronary angioplasty in an obese, diabetic, elderly woman treated with fondaparinux? The invited expert's opinion

摘要

This is a case of intra-procedural thrombus formation in the left main coronary artery. Unknown procedural factors, such as inadequate dosing of antithrombotics, chemical irritation of any inter-ventional device, or coronary dissection might have caused the complication. Regarding the treatment strategy, wiring into the circumflex should be performed quickly for luminal patency and subsequent treatment. After wiring, aspiration thrombectomy using an aspiration catheter or a small (4 Fr or 5 Fr) guiding catheter with the mother-child technique should be performed in addition to the provisional use of a glycoprotein IIb/IIIa inhibitor.