[The use of the Export Catheter device in a patient with acute myocardial infarction for thrombotic occlusion of the venous graft on the left anterior descending coronary artery: a case report].

Abstract

Coronary angioplasty, eventually followed by stent implantation, represents the gold standard of acute myocardial infarction (AMI) treatment. Optimal reperfusion implies both patency of the infarct-related artery and a good myocardial microrevascularization with normal tissue reperfusion. The so called no-reflow phenomenon mainly occurs in the presence of highly thrombotic lesions, especially during primary angioplasty and it represents a negative prognostic factor of the outcome of AMI patients treated with angioplasty. A 77-year-old high-risk male patient, previous coronary artery bypass graft with the saphenous vein graft to the left anterior descending coronary artery for post-AMI angina in 1984, aided by 118 ambulance for anterior AMI was admitted to our cath-lab for primary coronary angioplasty. During the transport he was given aspirin i.v. 300 mg, heparin 5000 IU and abciximab (9.4 ml bolus plus infusion for 12 hours). The time of treatment (from symptom onset to first inflation) was about 90 min. Coronary angiography showed a massive thrombus occlusion of the vein graft with TIMI 0 distal flow. We employed the Export Catheter for mechanical aspiration of the occluding thrombus. The procedure was completed with direct stent implantation with good angiographic outcome. The use of thrombus aspiration and protection devices (filters or occlusive balloons) associated or not with the use of glycoprotein IIb/IIIa receptor blockers, has reduced the risk of distal embolization and of no-reflow phenomenon.

• Authors: Michele Romano, Francesca Buffoli, Corrado Lettieri, Renato Rosiello, Marco Aroldi, Helène Kuwornu, Luca Tomasi, Nicola Baccaglioni, Roberto Zanini
• Journal: Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology (Ital Heart J Suppl) Vol. 6 Issue 6 Pg. 394-7 (Jun 2005) ISSN: 1129-4728 [Print] Italy
• Vernacular Title: Utilizzo di Export Catheter in paziente con infarto miocardico acuto per occlusione trombotica del graft venoso su discendente anteriore: descrizione di un caso clinico.
• PMID: 16013434 (Publication Type: Case Reports, English Abstract, Journal Article)

Topics

• Aged
• Catheterization
• Electrocardiography
• Graft Occlusion, Vascular (surgery)
• Humans
• Male
• Myocardial Infarction (surgery)
• Reoperation
• Saphenous Vein
• Stents
• Suction (instrumentation)
• Treatment Outcome
• Venous Thrombosis (surgery)