Intracoronary Thrombectomy Using an Off-Label 7-F Power Aspiration System for Inferior STEMI With Large Thrombus Burden.

BACKGROUND

Significant thrombus burden can hinder successful reperfusion after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. Thrombectomy devices may help reduce thrombus load, with recent advancements such as continuous vacuum aspiration now available through catheters connected to the Penumbra ENGINE.

CASE SUMMARY

We present the case of a 79-year-old woman with inferior ST-segment elevation myocardial infarction and significant thrombus burden in an ectatic right coronary artery, in which the use of 7-F Lightning 7 aspiration tubing (Penumbra) achieved effective clot retrieval and enabled successful percutaneous coronary intervention.

DISCUSSION

Lightning 7 aspiration tubing is not approved by the Food and Drug Administration for coronary intervention, making this, to our knowledge, the first reported case of successful coronary thrombus aspiration using a 7-F continuous aspiration catheter. Delivery to the distal right coronary artery required very supportive wires, and while the larger lumen enabled more effective thrombus removal, careful attention to blood loss is essential.

TAKE-HOME MESSAGE: Lightning 7 aspiration tubing may be safe and feasible to use in appropriately sized coronary arteries; however, distal vessel access is limited.