Introduction

Over the past thirty years, primary percutaneous interventions is widely used in cases of acute myocardial infarction espacially which one is with hemodinamic instability. Although conventional percutaneous interventions are more effective than the thrombolytic therapy in acute myocardial infarction (MI), reduced coronary flow and distal embolization frequently complicate interventions when thrombus is present. Adjunctive treatment with mechanical thrombectomy devices may reduce these complications.

Case

A 75-year-old female admitted to ER for crushing epigastric pain which started after dinner with cold sweats and lasted for 15 minutes.

On admission she was pain free. She had also hypertension and atrial fibrillation. Physical examination was unrevealing.

Initial echocardiographic findings were within normal limits. WBC: 13.800 / ml;

Tn I: >50 ng / ml and CK-MB: 67 U/L. Coronary angiography was performed and revealed that CFX and RCA were normal, but big thrombus burden was present at distal segment of LAD. Our initial approach was to give antiplatelet, anticoagulant therapy. Since the patient was pain free and the flow in LAD was unobstructed we gave enoxaparin, tirofiban, aspirin and clopidogrel. The patient stayed asymptomatic and a control angiogram was performed two days later. Thrombus in distal LAD was still visible without any signs of resolution. We proceeded to thrombectomy, using a 4.3 F thrombectomy catheter. After several attempts, the majority of the thrombus was aspirated. Laboratory analysis after thrombectomy revealed that WBC: 11500 / ml and Tn I: >10,108 ng / ml.