Patient History

• 52 year old male
• Former smoker, diabetes, hypertension, hyperlipidemia
• History of coronary artery disease
  • Prior stent to the LAD and D1
  • Prior stent to the circumflex
  • Prior stent to the RCA
  • Inferior MI secondary to stent thrombosis in January 2014 was treated with a second layer of stents in the proximal, mid, and distal RCA
  • Presented with a second stent thrombosis of the RCA in January 2015 which was treated with PTCA and stenting of the mid RCA (3rd layer)
• Patient presented with chest pressure and inferior ST elevation approximately 3 months later
• Patient was referred for coronary angiography

Diagnostic Angiogram

• Initial angiogram showed TIMI 0 flow
• Initial angiogram showed thrombus grade of 5
• The left main and left anterior descending arteries had no significant lesions. The stents in the LAD and D1 were patent
• The circumflex had no significant lesions. The stent in the first OM had a 50% lesion and the stents in the mid circumflex were patent
• The RCA was occluded in the mid vessel (Cine 1: Occluded RCA Acute Stent Thrombosis)

Procedure

• The patient was anticoagulated with heparin and Integrilin™
• Vascular access was gained utilizing a 6 F JR4 guiding catheter and a 190 cm wire
• Post wire TIMI flow was 0; post wire thrombus grade was 5
• The RCA was treated with ANGIOJET thrombectomy utilizing the SPIROFLEX catheter
• There was residual thrombus in the mid and distal stents (Cine 2: AngioJet)

• Initially the mid and distal RCA into the posterior lateral artery were treated with multiple SPIROFLEX passes for a total of 27.5 seconds
• A second series of runs was performed utilizing SPIROFLEX ANGIOJET for a total of 35 seconds
• Significant angiographic improvement was observed post mechanical thrombectomy
• Post ANGIOJET thrombus grade was 3 (Cine 3: Post AngioJet)

Definitive Treatment

Following PTCA with stenting, final TIMI flow was 3; final thrombus grade was 0 (Cine 4: Final Result Post Definitive Treatment).

Physician Commentary

As in this case, patients presenting with recurrent thrombosis over a long stented segment often have a large thrombus burden.

The ANGIOJET Thrombectomy System is ideal to treat patients with a considerable amount of large thrombus and in this patient the ANGIOJET successfully removed a significant thrombus from the mid and distal RCA making definitive treatment easier and reestablishing TIMI 3 flow.

This case demonstrates the utility of mechanical thrombectomy with the ANGIOJET SYSTEM in a patient presenting with a STEMI secondary to stent thrombosis and a substantial thrombus burden in the culprit vessel.