AngioJet™ Ultra Coronary Thrombectomy System Case Study
- 52 year old male
- Former smoker, diabetes, hypertension, hyperlipidemia
- History of coronary artery disease
- Prior stent to the LAD and D1
- Prior stent to the circumflex
- Prior stent to the RCA
- Inferior MI secondary to stent thrombosis in January 2014 was treated with a second layer of stents in the proximal, mid, and distal RCA
- Presented with a second stent thrombosis of the RCA in January 2015 which was treated with PTCA and stenting of the mid RCA (3rd layer)
- Patient presented with chest pressure and inferior ST elevation approximately 3 months later
- Patient was referred for coronary angiography
- Initial angiogram showed TIMI 0 flow
- Initial angiogram showed thrombus grade of 5
- The left main and left anterior descending arteries had no significant lesions. The stents in the LAD and D1 were patent
- The circumflex had no significant lesions. The stent in the first OM had a 50% lesion and the stents in the mid circumflex were patent
- The RCA was occluded in the mid vessel (Cine 1: Occluded RCA Acute Stent Thrombosis)
- The patient was anticoagulated with heparin and Integrilin™
- Vascular access was gained utilizing a 6 F JR4 guiding catheter and a 190 cm wire
- Post wire TIMI flow was 0; post wire thrombus grade was 5
- The RCA was treated with ANGIOJET thrombectomy utilizing the SPIROFLEX catheter
- There was residual thrombus in the mid and distal stents (Cine 2: AngioJet)
- Initially the mid and distal RCA into the posterior lateral artery were treated with multiple SPIROFLEX passes for a total of 27.5 seconds
- A second series of runs was performed utilizing SPIROFLEX ANGIOJET for a total of 35 seconds
- Significant angiographic improvement was observed post mechanical thrombectomy
- Post ANGIOJET thrombus grade was 3 (Cine 3: Post AngioJet)
Following PTCA with stenting, final TIMI flow was 3; final thrombus grade was 0 (Cine 4: Final Result Post Definitive Treatment).
As in this case, patients presenting with recurrent thrombosis over a long stented segment often have a large thrombus burden.
The ANGIOJET Thrombectomy System is ideal to treat patients with a considerable amount of large thrombus and in this patient the ANGIOJET successfully removed a significant thrombus from the mid and distal RCA making definitive treatment easier and reestablishing TIMI 3 flow.
This case demonstrates the utility of mechanical thrombectomy with the ANGIOJET SYSTEM in a patient presenting with a STEMI secondary to stent thrombosis and a substantial thrombus burden in the culprit vessel.