Korean Circ J.  2015 May;45(3):248-252. 10.4070/kcj.2015.45.3.248.

Mechanical Extraction of a Massive Intracoronary Thrombus from the Super-Dominant Right Coronary Artery in Thrombogenic Lung Cancer Patient

• Kim DK
• Ko SH
• Seo GW
• Song PS
• Kim KH
• Seol SH
• Song JW
• Kim DI

• KMID: 2389134
• DOI: http://doi.org/10.4070/kcj.2015.45.3.248

Abstract

The congenital absence of the left circumflex artery and a compensatory super-dominant right coronary artery (RCA) is a very rare benign coronary anomaly in the clinic. The presence of a massive thrombus in the super-dominant RCA can lead to fatal results in cases of acute myocardial infarction, unless the thrombus is mechanically removed. Aspiration of the thrombus using a 6 Fr right Judkins guide catheter is useful to extract a massive thrombus and is both safe and effective. We report a case of complete revascularization of the super-dominant RCA after thrombus aspiration using a 6 Fr Judkins right catheter in a patient with acute inferior and inferolateral wall myocardial infarction.

Keyword

Coronary thrombosis; Coronary vessel anomalies; Inferior wall myocardial infarction

MeSH Terms

Catheters
Coronary Thrombosis
Coronary Vessel Anomalies
Coronary Vessels*
Humans
Inferior Wall Myocardial Infarction
Lung Neoplasms*
Myocardial Infarction
Thrombosis*

Figure

• 

  Fig. 1 Baseline coronary angiogram. A and B: the left circumflex artery is not seen in both caudal view and left-anterior-oblique with caudal view of the left coronary angiogram. C: massive thrombotic occlusion in super-dominant right coronary artery is noted on the right coronary angiogram.

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  Fig. 2 Coronary thrombus aspiration with 6 Fr guide catheter. A: the Judkins right guide catheter (arrow) can be deeply positioned into the super-dominant right coronary artery using a clock-wise rotation. B: the massive fresh thrombus is successfully removed by direct catheter aspiration.

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  Fig. 3 Final coronary angiogram and repeated coronary angiogram. A: after the effective extraction of the massive thrombus, distal trees of the right coronary artery appears and extends to the territory of the left circumflex artery. B: remnant intracoronary thrombus almost disappears after continuous intravenous administration of unfractionated heparin for eight days. C, D, and E: atheromatous plaque or ruptured plaque is not observed on the intravascular ultrasound. *small remnant thrombus.

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  Fig. 4 An acute pulmonary thromboembolism develops two weeks after discharge under dual antiplatelet therapy with no evidence of hypercoagulopathies. A chest CT scan shows intra-arterial emboli (arrows) in the right lower basal segmental pulmonary arteries.

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