Patient History

• 64 year old male
• Former smoker
• History of hypertension
• Presented with chest pressure relieved by nitroglycerine in the emergency department
• EKG demonstrated less than 1 mm of ST depression in the anterior leads
• Subsequently the troponin increased to 7.23 ng/mL
• Patient was referred for coronary angiography

Diagnostic Angiogram

• Initial angiogram showed TIMI 3 flow
• Pre-wiring, the thrombus grade was 3
• The left main and left anterior descending arteries had no significant lesions
• The first obtuse marginal had a sub-total long thrombotic lesion in the proximal vessel (Cine 1: Diagnostic Angiogram)
• The RCA had a 70% proximal lesion and a 70% mid-vessel lesion

Procedure

• Patient was anticoagulated with heparin
• Post wiring, the thrombus grade was 3 (Cine 2: Post Wire)

• The obtuse marginal was treated with manual aspiration thrombectomy utilizing the FETCH2 Aspiration Catheter
• A moderate amount of red thrombus was removed (Cine 3: FETCH2)

• Post FETCH2, the thrombus grade was 2
• Angiographic improvement was observed post thrombectomy (Cine 4: Post FETCH2)

Definitive Treatment

Following PTCA with stenting and post-dilatation, the final thrombus grade was 0 with TIMI flow 3 (Cine 5: Definitive Treatment).

Physician Commentary

• Percutaneous coronary intervention in thrombotic lesions may result in distal embolization, slow flow, and possibly re-infarction
• Removal of thrombus prior to intervention may prevent these complications
• Manual aspiration thrombectomy is a simple and effective method to treat patients with thrombotic coronary lesions
• This case demonstrates how the removal of small-to-moderate thrombus with the FETCH2 catheter can facilitate the definitive treatment and reestablish flow