Successful Thrombosuction of Ruptured Plaque Migrated into the Bifurcation of LAD and Diagonal Branch

Dr. Jae-Bin SEO

Boramae Medical Center, Seoul, Korea

 

A 73-year-old woman who had hypothyroidisms and hypertension complaining of chest pain during exertion. Treadmill test was positive. CT coronary angiogram showed proximal LAD ostium 90% stenosis and proximal LAD 30-40% stenosis (Movie 1, Movie 2).

We performed successful wiring with floppy wire and ballooning with 2.5x12mm balloon. Then, we implanted 3.0x12mm DES (Movie 3, Movie 4). Thereafter, we performed adjunctive ballooning with 3.0x8mm balloon (Movie 5). Unfortunately, after ballooning, no reflow phenomenon was observed (Movie 6). Therefore, intracoronary nicorandil was given and additional ballooning was done. Then, we could find thrombus which was located at both LAD and diagonal branch (Movie 7). Thrombosuction was done at LAD, but it could not be aspirated. However, when thrombosuction at diagonal branch was tried, the thrombus was aspirated successfully. The shape was crescent moon (Figure 1). After thrombosuction, we could finalize intervention (Movie 8).

The possible cause was suspected due to:

  • Inadequate anti-coagulation

  • Landing of distal stent edge at plaque and oversize of post-dilatation balloon result in stent edge dissection and thrombus formation