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Perspective | Open Access

How to effectively manage the refractory coronary thrombus? A systemic mini-review

Song ZHANG^¹, Dang-Hui SUN^¹, Shuang LI^¹, Yue LI^{¹^,²^,³^,⁴^,⁵}()

1

Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China

2

NHC Key Laboratory of Cell Translation, Harbin Medical University, Harbin, China

3

Key Laboratory of Hepatosplenic Surgery, Harbin Medical University, Ministry of Education, Harbin, China

4

Key Laboratory of Cardiac Diseases and Heart Failure, Harbin Medical University, Harbin, China

5

Heilongjiang Key Laboratory for Metabolic Disorder & Cancer Related Cardiovascular Diseases, Harbin, China

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Abstract

The main management principle for patients with coronary thrombus should be “more removal and less implantation”. Routine thrombus aspiration (TA) is ineffective for intracoronary thrombus or high residual thrombus burden after TA and may result in a refractory coronary thrombus. It is unwise to implant a stent in the vessel with high residual thrombus, which is associated with no-reflow, impaired microvascular perfusion, and consequently worse clinical outcomes. Therefore, increasing the efficiency of TA during percutaneous coronary intervention procedures, especially under some conditions of refractory coronary thrombus, is very important to restore myocardial reperfusion and improve microvascular dysfunction early. In the present work, we aimed to demonstrate the factors that may affect TA efficiency and introduce several highly effective approaches to treat refractory coronary thrombus.

References

[1]

Jolly SS, Cairns JA, Yusuf S, et al. Randomized trial of primary PCI with or without routine manual thrombectomy. N Engl J Med 2015; 372: 1389−1398.

Crossref Google Scholar

[2]

Fröbert O, Lagerqvist B, Olivecrona GK, et al. Thrombus aspiration during ST-segment elevation myocardial infarction. N Engl J Med 2013; 369: 1587−1597.

Crossref Google Scholar

[3]

Bhindi R, Kajander OA, Jolly SS, et al. Culprit lesion thrombus burden after manual thrombectomy or percutaneous coronary intervention-alone in ST-segment elevation myocardial infarction: the optical coherence tomography sub-study of the TOTAL (ThrOmbecTomy versus PCI ALone) trial. Eur Heart J 2015; 36: 1892−1900.

Crossref Google Scholar

[4]

Vlaar PJ, de Smet BJ, van den Heuvel AF, et al. Operator dependence of outcome after primary percutaneous coronary intervention. EuroIntervention 2011; 6: 760−767.

Crossref Google Scholar

[5]

Higuma T, Soeda T, Yamada M, et al. Does residual thrombus after aspiration thrombectomy affect the outcome of primary PCI in patients with ST-segment elevation myocardial infarction? An optical coherence tomography study. JACC Cardiovasc Interv 2016; 9: 2002−2011.

Crossref Google Scholar

[6]

Hara H, Nakamura M, Komatsu H, et al. Comparison of the in vitro performance of 6 and 7 French aspiration catheters. EuroIntervention 2007; 2: 487−492.

[7]

Takahashi S, Saito S, Tanaka S, et al. New method to increase a backup support of a 6 French guiding coronary catheter. Catheter Cardiovasc Interv 2004; 63: 452−456.

Crossref Google Scholar

[8]

Li Y, Xue JY, Sun YM, et al. [Successful coronary intractable thrombus aspiration with sub-5F catheter in three patients]. Zhonghua Xin Xue Guan Bing Za Zhi 2014; 42: 878−879. [In Chinese].

Crossref Google Scholar

[9]

Sheng L, Li JQ, Sun DH, et al. Removal of refractory thrombus by 5F child catheter in patients with subacute myocardial infarction. J Geriatr Cardiol 2019; 16: 168−172.

Crossref Google Scholar

[10]

Moretti A, Sanz Sanchez J, Petriello G, et al. Ultra-deep guide catheter intubation for direct thromboaspiration in acute myocardial infarction. Cardiovasc Revasc Med 2019; 20: 49−50.

Crossref Google Scholar

[11]

Kusumoto H, Hasegawa K, Ishibuchi K, et al. A novel treatment using a guide extension catheter and distal protection device for refractory coronary embolism: case report. Eur Heart J Case Rep 2021; 5: ytaa507.

Crossref Google Scholar

[12]

Jain A, Weerackody R, Kennon S, et al. Prevention of thrombus embolization during primary percutaneous intervention using a novel mesh covered stent. Catheter Cardiovasc Interv 2009; 74: 88−93.

Crossref Google Scholar

[13]

Uribe CE, Zuñiga M, Madrid C. Mechanical thrombectomy using the Solitaire stent in a left main coronary artery: a novel approach to coronary thrombus retrieval. Catheter Cardiovasc Interv 2017; 89: 71−77.

Crossref Google Scholar

[14]

Khoo DZL, Lee JH, Watson TJ, et al. The Solitaire device: on the cards for retrieval of recalcitrant thrombus in acute coronary syndrome. EuroIntervention 2019; 14: e1834−e1835.

Crossref Google Scholar

[15]

Scalone G, Brugaletta S, Garcia-Garcia HM, et al. Frequency and predictors of thrombus inside the guiding catheter during interventional procedures: an optical coherence tomography study. Int J Cardiovasc Imaging 2015; 31: 239−246.

Crossref Google Scholar

[16]

Collins N, Horlick E, Dzavik V. Triple wire technique for removal of fractured angioplasty guidewire. J Invasive Cardiol 2007; 19: E230−E234.

[17]

Demircan S, Yazici M, Durna K, et al. Intracoronary guidewire emboli: a unique complication and retrieval of the wire. Cardiovasc Revasc Med 2008; 9: 278−280.

Crossref Google Scholar

[18]

Devidutta S, Lim ST. Twisting wire technique: an effective method to retrieve fractured guide wire fragments from coronary arteries. Cardiovasc Revasc Med 2016; 17: 282−286.

Crossref Google Scholar

[19]

Zou YL, Li JQ, Gong YT, et al. A novel treatment of refractory coronary embolism: thrombus aspiration catheter-assisted twisting wire technique. J Geriatr Cardiol 2020; 17: 110−115.

Crossref Google Scholar

Journal of Geriatric Cardiology

Volume 20 Issue 4,
April 2023

Pages 309-313

DOI: 10.26599/1671-5411.2023.04.003

Cite this article:

ZHANG S, SUN D-H, LI S, et al. How to effectively manage the refractory coronary thrombus? A systemic mini-review. Journal of Geriatric Cardiology, 2023, 20(4): 309-313. https://doi.org/10.26599/1671-5411.2023.04.003

Figure 1The Export AP catheter is used to treat a case of iatrogenic thromboembolism. (A): The initial angiography showed a lesion at the mid to distal end of the LCX; (B): the LCX was implanted with a 3.0 mm × 18 mm drug eluting stents; (C): after post-dilation by a 3.25 mm × 10 mm non-compliant balloon, the final angiography was shown; (D): three days later, the patient was performed radiofrequency ablation and implanted with a temporary pacemaker. During angiography, the patient suddenly occurred severe chest pain, and the electrocardiogram showed an ST-segment elevated in II, III, and aVF leads; (E): the angiography demonstrated that the LCX was occluded, and the thrombus was within the original stent, which was suspected of iatrogenic thromboembolism from the guiding system. Then, thrombectomy by a Diver CE catheter; (F & G): post-dilation by a 3.0 mm × 15 mm non-compliant balloon were conducted; (H): there was still a heavy thrombus burden in-stent of LCX; (I): an Export AP aspiration catheter was performed from the distal end of LCX; (J): the angiography image showed the final satisfactory results with no residual thrombus; (K): the picture of the representative extracted thrombus showed that its appearance looked like a piece of meat; and (L): the representative image of histopathological examination by hematoxylin and eosin staining showed a white thrombus with a minor mixed thrombus. LCX: left circumflex artery.
Figure 2The ‘Mother-in-child catheter’ technique is used to treat acute thrombosis in the LM artery. (A): On 22 April 2011, a male patient who presented with angina pectoris underwent coronary angiography, which showed bifurcation stenoses (Medina class 1.1.0). Diffusely severe stenosis along the LM and LAD was observed; (B): the LM to LAD was sequentially implanted with a 4.0 mm × 28 mm and a 4.0 mm × 23 mm drug eluting stents; (C): the angiography showed that a 4.0 mm × 10 mm non-compliant balloon was used to post-dilate the LM and LAD stent; (D): after post-dilation, an acute thrombosis was seen in LM, the patient was accompanied by hemodynamic instability, and a temporary pacemaker was immediately placed into the right ventricular; (E): the remaining heavy thrombus was observed after the routine thrombus aspiration by an Export catheter. So, a 5Fr ‘Heartrail II-ST01’ catheter (white arrow) was advanced into the original 6Fr BL3.0 guiding catheter to extract the thrombus; and (F): the angiography image showed the final satisfactory results with no residual thrombus. LAD: left anterior descending artery; LM: left main.
Figure 3Demonstration of the ‘3D-shaped’ tip of the second guidewire. (A): The first U-shaped tip; and (B): different views of the second U-shaped curve at a location perpendicular to the first one to form a ‘3D-shaped’ tip.
Figure 4Description of the ‘thrombus aspiration catheter-assisted twisting wire technique’. (A): Advance the first guidewire (black) through the embolus; (B): advance the aspiration catheter over the wire and shape the head of the second guidewire (pink) into a ‘3D’ pattern. Advance the second guidewire through the embolus as far as possible with the assistance of the thrombus aspiration catheter; (C): pull back the aspiration catheter into the guiding catheter; (D): rotate the second guidewire continuously in one direction; (E): withdraw the twisted guidewires with the retrieved embolus into the guiding catheter and pull the guiding catheter out; and (F): final results.

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