CORONARY - Acute Coronary Syndromes (STEMI, NSTE-ACS)
High Thrombus Burden of Right Coronary Artery
Norhaliza Am Haris1
National Heart Institute, Malaysia1,
Patient initials or Identifier Number
Relevant Clinical History and Physical Exam
Mr. MINM, a 66 years old gentleman who has underlying poorly controlled diabetes on insulin presented to our center with typical angina symptoms 4 hours prior to the admission. His ECG on arrival to emergency department showed ST elevation over V3-V6 leads and II, III, aVF leads with ST depression over I, aVL leads. His vital signs were stable and physical examinations were unremarkable. He then treated as acute extensive anterior myocardial infarction and pushed for primary PCI.
Relevant Test Results Prior to Catheterization
Normal full blood countKidney profile showed CKD stage 4 with urea of 15/ crea 325 eGFR 17, potassium was 5.8Blood sugar was 20 on arrival. Mild metabolic acidosis noted on blood gas.Troponin T was highly elevated >10,000 pg/ml
Relevant Catheterization Findings
This is a case of high thrombus burden in rightcoronary artery who came with acute myocardial infarction. We practiced intracoronary thrombus aspiration with export and Penumbra catheter together with intracoronary intracoronary glycoprotein (GP) IIb/IIIa antagonists, despite all his thrombus remain high. As implanted coronary stents in a large thrombus burden coronary artery may be associated with distal embolization, impaired flow with an increased risks of peri-procedural complications, our strategies are to defer the coronary stenting and started him on anticoagulant with antiplatelet medications and restudy back later with the aim of resolution or reduction of the heavy thrombus.