Migration of a thrombus Migration of a thrombus in coronary arteriesin coronary arteries

Sakhov O.S., Kenzhebaev A.M., Mukanov S.M.

City Heart Center, Almaty, Kazakhstan

HistoryHistory

Patient I., female, 69 y.o.

Risk factors: dyslipidemia

Diagnosis: STEMI

Chest pain with 5 hours duration, without

previous coronary anamnesis

ECG: 4 mm ST elevation in anterior leads

Troponin: 0,352 ng/ml

Coronaroangiography:Coronaroangiography:

LAD – occlusion of ostium.Cx – no significant stenosisRCA - dominant, no stenosis. A. intermediate – stenosis (40%) in proximal segment.

Primary PCIPrimary PCI

Right femoral access. Guiding catheter 6 Fr JL 4.0. The occlusion was easily crossed using a 0.014” BMW guidewire.Predilation with a 2.0x15mm Sprinter balloon at 12atm. Antegrade filling of the distal segment LAD (TIMI 2).

Stenting of infarct-related arteryStenting of infarct-related artery

Diagonal branch was not protected.

Stent Cypher Select 3.0x23mm was implanted at 18 atm.

ResultResult

• Good angiographic effect, DB is not occluded• But patient had intensive chest pain• Analysis of the previous series showed that the intermediate artery was occluded after 1st balloon inflation in the LAD.•2nd guide wire crossed trough the occlusion and performed pre-dilatation of proximal segment of intermediate artery.

New lost arteryNew lost artery

Patency of the a.intermediate was restored.Now was occluded distal segment of obtuse marginal. Several balloon dilatations were performed without improvement of distal flow. Intervention was stopped.Patient was discharged on the 4th day in stable condition.

ResumeResume::

Migration of a thrombus is dangerous complication with the risk of new MI.

During the PCI, the operator's attention should be not only in the occluded artery.

Using of aspiration catheter could reduce the risk of this complication.