A 53-year-old male non-smoker with hypertension and hypercholesterolemia (LDL:215MG/DL) presented 2 hours after sudden onset of severe chest pain with persistent angina and ST elevations in the inferior leads. He received electroshocks because of ventricular fibrilation in the emergency department. Emergent coronary angiography showed right coronary artery (RCA) occlusion distal to a fusiform aneurysm of the proximal RCA and an occlusion of the vessel downstream due to a huge organized thrombus. There were also aneurysmatic and ectatic segments in the mid portion of left anterior descending and distal left circumflex arteries. An aspiration catheter was advanced to the RCA to aspirate the thrombus over an intermediate guidewire. A huge warm-like (>3cm) red thrombus was retrived from the guiding catheter by applying negative pressure. After the successful thrombectomy, TIMI 3 coronary flow was restored and ST elevation and chest pain of the patient resolved. Glycoprotein IIb/IIIa antagonist was administered during and 48 hours after the procedure along with unfractioned heparin, clopidogrel and ASA. The postoperative course was uneventful and the left ventricular ejection fraction was within the normal range without any wall motion abnormality.
