A 56-year-old male with current smoking and dyslipidemia was admitted to our hospital because of anterior ST-segment elevation myocardial infarction (STEMI). Echocardiogram showed akinesis in the apex of the left ventricle, and the ejection fraction was 55%. There was no evidence of atrial fibrillation, cardiac shunts or any cardiac thrombus. He had no history of the emotional stress, cocaine intake or thrombophilia. And, also there was no episode that suspected coronary spasm. After administration of aspirin 200mg and prasugrel 20mg, the emergent coronary angiogram (CAG) was performed. CAG showed the total occlusion at the distal portion of left anterior descending artery (LAD) (Figure 1A, Video 1). Manual thrombus aspiration was performed, and small red thrombi were aspirated.
2. Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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