PMC4777712_01
A - Initial angiography, the site of the LAD occlusion (thin arrow) and the patent LCx. B - The site of the LCx occlusion by the material translocated from the LAD during aspiration thrombectomy using the Export AP (thin arrow). C - Manual aspiration thrombectomy with a guide extension mother-and-child catheter (arrow); protection from distal embolism is provided by an inflated balloon catheter (thin arrow). D - The previous site of the LCx occlusion (thin arrow) after aspiration with a guide extension catheter (arrow) - complete removal of the embolic material. E - Embolic material extracted from the LCx. F - Histopathological specimen of the extracted embolic material, purulent foci within thrombus (thin arrows)
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The coronary angiography revealed occlusion of the left anterior descending artery (LAD) (Figure 1 A). However, the final contrast injection revealed occlusion of the left circumflex artery (LCx) (Figure 1 B), presumably by material translocated during withdrawal of the AT device. First a 2.0 x 20 mm balloon catheter was inflated beyond the site of the occlusion in order to ensure protection from distal embolism and facilitate the guide extension catheter advancement (Figure 1 C). Subsequently, the Heartrail II-ST01 5 Fr (Terumo Medical) catheter was positioned proximal to the site of the occlusion (Figure 1 C). TIMI 3 flow restoration (Figure 1 D). The patient's further clinical course was uneventful. Histological examination of the aspirated material revealed thrombus with purulent foci, the picture suggestive of bacterial vegetation (Figure 1 F).