Lots of interesting abstracts and cases were submitted for TCTAP 2024. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!
TCTAP C-004
Mechanical Thrombus Aspiration in STEMI
By Vicknesan Kulasingham, Mahadevan Gurudevan, Kamaraj Selvaraj, Heng Shee Kim, Kim Fong Ng
Presenter
Vicknesan Kulasingham
Authors
Vicknesan Kulasingham1, Mahadevan Gurudevan2, Kamaraj Selvaraj3, Heng Shee Kim4, Kim Fong Ng4
Affiliation
Ministry of Health Malaysia, Malaysia1, Sultanah Amina Hospital, Malaysia2, Sultan Idris Shah Serdang Hospital, Malaysia3, Sultanah Aminah Hospital, Malaysia4,
View Study Report
TCTAP C-004
Coronary - ACS/AMI
Mechanical Thrombus Aspiration in STEMI
Vicknesan Kulasingham1, Mahadevan Gurudevan2, Kamaraj Selvaraj3, Heng Shee Kim4, Kim Fong Ng4
Ministry of Health Malaysia, Malaysia1, Sultanah Amina Hospital, Malaysia2, Sultan Idris Shah Serdang Hospital, Malaysia3, Sultanah Aminah Hospital, Malaysia4,
Clinical Information
Patient initials or Identifier Number
Relevant Clinical History and Physical Exam
47 years old male presented to the emergency department with typical angina pain at 8am. No failure symptoms. He has a past history of hypertension under primary care follow-up. He is an active smoker and no family history of heart disease. On arrival, GCS was full, hemodynamically stable and no clinical signs of failure. He presented to the hospital at 11am.
Relevant Test Results Prior to Catheterization
Hemoglobin: 150g/L, WBC: 16.9x10^9/L, Platelets: 309x10^9/LSodium: 136 mmol/L, potassium: 3.5mmol/L, urea: 3.8mmol/L, creatinine: 88micromol/LTG: 0.9mmol/L, TC: 5.5mmol/L, LDL: 4.1mmol/LFasting blood sugar: 5.3mmol/LTroponin: 53884 ng/L
Relevant Catheterization Findings
Proximal to Mid LAD: 60-80%, small aneurysm at mid LADMid left circumflex 80%PRCA Acute total occlusion
Interventional Management
Procedural Step
Primary PCI for Inferior STEMI. Right femoral approach. Engaged with 6Fr JR4 and wired down with Sion blue wire with Finecross Microcatheter. Initially did manual thrombus aspiration and minimal red thrombus aspirated. Repeated angiogram showed proximal RCA still acutely occluded with TIMI 0 flow. Proceeded with thrombus aspiration with Penumbra. Subsequently achieved TIMI 3 flow in RCA with significant stenosis proximal RCA to mid RCA. Predilated with NC 2.5x15mm at 14-22ATM. Stented MRCA with DES CRE8 EVO 3.0x33mm and PRCA with DES 3.5x33mm. Post dilated with NC 3.5x15mm at 14-22ATM. TIMI 3 flow and no dissection. Successful PCI.
Case Summary
Primary PCI especially with high thrombus burden is associated with slow flow/ no reflow phenomenon and distal embolization which in turn leads to high mortality and morbidity. Even though prior studies showed no benefit in routine manual thrombus aspiration, studies have shown that mechanical thrombus aspiration especially in high thrombus burden acute coronary syndrome was safe, associated with high rates of thrombus removal and reduces slow flow/ no reflow phenomenon.