Coronary stent retriever-assisted thrombectomy

ST-segment elevation myocardial infarction (STEMI) with a large thrombus burden (LTB) remains a prognostically relevant clinical challenge. However, thrombus aspiration, the prevailing approach to thrombus modification during STEMI, has not shown efficacy in randomised studies. Meanwhile, in stroke intervention, stent retriever-assisted thrombectomy has demonstrated clear efficacy1.

Whether stent retriever-assisted thrombectomy could play a role in STEMI patients with an LTB remains unanswered. Only case reports suggest the feasibility of this approach, while ongoing studies aim to evaluate its effectiveness in enhancing thrombus extraction2.

Here we present unique images visualising the impact of stent retriever-assisted thrombectomy in a patient admitted with STEMI and LTB, and in a coronary bench model.

A 69-year-old male presented to our institution with an inferior STEMI due to a thrombotic occlusion of the left circumflex artery. Coronary flow was restored with a 2 mm semicompliant balloon, revealing a large filling defect at the site of occlusion on angiogram (Figure 1A, Moving image 1); this filling defect was confirmed to be a large volume of thrombus by optical frequency domain imaging (OFDI; Lunawave [Terumo])...