The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

How should I treat?

How should I treat a massive thrombus embolisation in the left coronary artery during chronic total occlusion revascularisation?

EuroIntervention 2012;8:866-875. DOI: 10.4244/EIJV8I7A130

1. Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy; 2. Interventional Cardiology Unit, S. Giovanni di Dio Hospital, Agrigento, Italy

BACKGROUND: A 53-year-old man symptomatic for unstable angina, underwent PCI for a severe stenosis of the first obtuse marginal and a CTO of the left circumflex arteries.

INVESTIGATIONS: Physical examination, myocardial necrosis markers, ECG, transthoracic echocardiography, exercise ECG test, bilateral coronary angiography, cardiac magnetic resonance.

DIAGNOSIS: During PCI, antegrade contrast injection displaced a large clot from the guiding catheter into the left coronary artery causing massive thrombosis. The patient became haemodynamically unstable. The pressure wave from the guiding catheter was damped.

MANAGEMENT: Intravenous UFH and abciximab followed by aspiration from the guiding catheter, and ...

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