PMC8274647_01
Electrocardiogram (ECG) results. (A) The pre procedural electrocardiogram revealed an ST-segment elevation in the V2-6 leads; (B) The post-procedural electrocardiogram showed an improvement in ST-segment elevation in the V3-6 leads.
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The electrocardiogram revealed an ST-segment elevation in the V2-6 leads (Figure 1) and echocardiography showed anteroseptal hypokinesis, indicating an anterior ST-elevation myocardial infarction (STEMI).
Coronary angiography results. (A) Initial angiography. Total occlusion of the middle left anterior descending artery (TIMI Grade 0); (B) Distal protection device was advanced through, to the distal part of the occluded lesion; (C) Thrombus aspiration using the thrombectomy using an aspiration catheter; (D) Persisting high-grade thrombus after unsuccessful aspiration; (E) Capturing the entire thrombus between the tip of the GuideLiner  Catheter and the filter body of the Filtrap , and pulling them out of the guide catheter together; (F) Final results: coronary flow restoration after successful thrombus aspiration (TIMI Grade 3).
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Emergency coronary angiography revealed no significant stenosis in the right coronary artery, while the left anterior descending artery (LAD) showed an acute thrombotic occlusion in the mid-section (Figure 2A). First, the Filtrap  was advanced through to the distal part of the occluded lesion in order to avoid distal embolism during the procedure (Figure 2B). Although thrombectomy using an aspiration catheter was performed repeatedly, only a small portion of the thrombus was retrieved (Figure 2C), and the LAD was still occluded with a heavy thrombus burden (Figure 2D). Therefore, we planned to remove the heavy thrombus burden by capturing the entire thrombus between the tip of the GuideLiner  catheter and the filter body of the Filtrap, followed by pulling them out of the guide catheter together (Figures 2E, 3A, 4). A large quantity of red thrombus, which adhered to the axis of the filter device, was successfully retrieved (Figures 2F, 3B, 5).
Capturing the entire thrombus. (A) Capturing the thrombus between the tip of the GuideLiner  Catheter and the filter body of the Filtrap ; (B) Large thrombus was extracted.
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Therefore, we planned to remove the heavy thrombus burden by capturing the entire thrombus between the tip of the GuideLiner  catheter and the filter body of the Filtrap, followed by pulling them out of the guide catheter together (Figures 2E, 3A, 4). A large quantity of red thrombus, which adhered to the axis of the filter device, was successfully retrieved (Figures 2F, 3B, 5).
This figure (Video 1) shows the steps of the procedure; 1. Inserting the filter device (Filtrap ) and unfolding it beyond the occlusion; 2. Advancing the guide extension catheter (GuideLiner ) and capturing the huge thrombus between the tip of the GuideLiner  catheter and the filter body of the Filtrap ; 3. Pulling them back together out of the guide catheter.
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Therefore, we planned to remove the heavy thrombus burden by capturing the entire thrombus between the tip of the GuideLiner  catheter and the filter body of the Filtrap, followed by pulling them out of the guide catheter together (Figures 2E, 3A, 4).
Thrombus retrieved from the left anterior descending artery.
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A large quantity of red thrombus, which adhered to the axis of the filter device, was successfully retrieved (Figures 2F, 3B, 5).