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Thrombus Aspiration – Case Of An Old, Diabetic And Hypertensive Patient

Mumbai, 16th April, 2016: A 56 year old male diabetic and hypertensive patient had acute onset of chest pain. He was referred to SevenHills Hospital for tertiary care management. ECG was showing sinus rhythm, with ST elevation in lead II, III and AVF suggestive of acute inferior wall myocardial infarction. (Fig 1)

Thrombus Aspiration
Fig. 1

His blood pressure was 100/60mmhg, pulse was 94 /min. He was immediately shifted to cath lab for primary PCI. Angiogram revealed total occlusion of RCA with grade 5 thrombus.(Fig 2)

Thrombus Aspiration
Fig. 2

After explaining the condition to relatives, a decision of primary angioplasty was taken. Considering the high load of thrombus, thrombus suction was done using a manual thrombus aspiration catheter.(Fig 3 and Fig 4)

Thrombus Aspiration Thrombus Aspiration
Fig. 3 Black marker on Angio shows the tip of aspiration catheter. Fig. 4 Thrombus aspiration catheter

Angiogram after thrombus aspiration showed good distal flow with a reduction in the amount of thrombus.(Fig 5)

Thrombus Aspiration
Fig. 5

A drug eluting stent was deployed at the site of lesion; final angiographic result was excellent. (Fig 6)

Thrombus Aspiration
Fig. 6

Post primary angioplasty the ECG showed complete resolution of ST elevation. (Fig 7)

Thrombus Aspiration
Fig. 7 Post PCI ECG shows complete resolution of ST elevation

Patient was discharged from hospital after 3 days in stable condition. On follow-up visit, patient was doing well with normal LV Left and Right ventricular systolic function on Echocardiogram.

“One of the most important therapeutic challenge in STEMI is establishment of near normal coronary flow , because reduced flow is associated with high mortality and heart failure’’ said Dr. Krupal Reddy, DM MD – Consultant Interventional Cardiologist of SevenHills Hospital, Mumbai.

“Thrombus aspiration may contribute to improve coronary artery flow post-PCI. Thrombus aspiration is easy, quickly performed, and a relatively cost effective adjunct to PCI. Use of thrombus aspiration has dramatically increased worldwide, especially after TAPAS trial, which was published in New England Journal of Medicine ’’

Tapas trial was done on nearly 1100 subjects, which showed a statistically significant reduction in cardiac death in patients treated with thrombus aspiration at one year compared to that who did not receive thrombus aspiration.