Lots of interesting abstracts and cases were submitted for TCTAP 2025. 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-040
Post-Acute Myocardial Infarction Clot Retrieval Using Thrombuster Aspiration and Intracoronary Tirofiban
By Samshol Sukahri
Presenter
Samshol Sukahri
Authors
Samshol Sukahri1
Affiliation
Kedah Medical Centre, Malaysia1,
View Study Report
TCTAP C-040
Coronary - Adjunctive Procedures (Thrombectomy, Atherectomy, Special Balloons)
Post-Acute Myocardial Infarction Clot Retrieval Using Thrombuster Aspiration and Intracoronary Tirofiban
Samshol Sukahri1
Kedah Medical Centre, Malaysia1,
Clinical Information
Patient initials or Identifier Number
Relevant Clinical History and Physical Exam
A 52-year-old woman with history of hypertension, dyslipidemia, and diabetes mellitus presented at a district hospital with classic symptoms of acute coronary syndrome. An initial electrocardiogram (ECG) performed revealed ST-segment elevation in the inferior leads, leading to a diagnosis of acute inferior myocardial infarction, Killip class I. she promptly received thrombolytic therapy . She was referred to our outpatient cardiology clinic for further intervention after 10 days discharged.
Relevant Test Results Prior to Catheterization
Her renal profiles revealed mild renal impairment and the echocardiogram were normal with preserve ejection fraction
Relevant Catheterization Findings
Her coronary angiogram revealed mild plaque over left anterior descending artery(LAD) and left circumflex artery (LCX) with acute total occlusion of right coronary artery (RCA)
Interventional Management
Procedural Step
The right coronary artery (RCA) was successfully engaged using a 6F JR 3.5 catheter. A runthrough Floppy wire was advanced into the RCA, crossing the acute total occlusion without resistance. The lesion was initially predilated using a 2.0 x 10 mm NC balloon, followed by escalation to a 3.0 x 15 mm NC balloon.Due to the presence of a heavy thrombus burden, a thrombuster aspiration catheter was employed for thrombus aspiration, repeated three times. Intracoronary adenosine (20 mg bolus) was administered twice. Subsequently, a drug-eluting stent (DES) measuring 3.5 x 34 mm was deployed in the mid-segment of the RCA.In view of the substantial thrombus load, intracoronary tirofiban (20 mg stat) was administered, followed by a 12-hour maintenance infusion. The procedure yielded excellent results, achieving TIMI III flow.
Case Summary
Managing a post-acute myocardial infarction presents significant challenges due to the organization of blood clots within the vessel. Successful outcomes require meticulous planning, including the use of thrombuster aspiration for clot removal, intracoronary adenosine to induce hyperemia and enhance microvascular circulation, and intracoronary GP IIb/IIIa inhibitors to address platelet aggregation. These strategies collectively improve the likelihood of procedural success.