A 48-year-old woman was referred to our department with an inferolateral STEMI ( Fig. 1A ). She received pretreatment with aspirin, a prasugrel loading dose (60 mg) and intravenous administration of 0.5 mg/kg enoxaparin.
Coronary angiography revealed proximal thrombotic occlusion of the LCx, without collateral flow ( Fig. 2A , Video 1 ). An intracoronary abciximab bolus (0.25 mg/kg body weight) was given immediately after the diagnostic angiograms. Thrombectomy with a dedicated catheter resulted in proximal reperfusion, however, distal embolization occurred ( Fig. 2B , Video 2 ). Despite multiple attempts at thromboaspiration, the distal thromboembolus remained ( Fig. 2C , Video 3 ). The patient underwent direct stenting of the proximal LCx with a bare-metal stent ( Fig. 2D and E , Video 4 ). Continuous abciximab infusion at 0.125 mcg/kg per min was given for 12 hours. At admission to the intensive care unit, the patient’s chest pain had resolved and an electrocardiogram showed minor persistent ST-segment elevation (0.1 mV) in the inferolateral leads ( Fig. 1B ). One hour later, we observed the onset of an accelerated idioventricular rhythm followed by ST-segment normalization ( Fig. 1C and D ). Troponin Ic was raised to 76 ng/mL (normal ≤ 0.04 ng/mL). Five days later, repeat coronary angiography confirmed complete resolution of the thrombus with TIMI 3 flow in the LCx ( Fig. 2F , Video 5 ).
