Comminution of a prolapsed thrombus after coronary stent implantation using cutting balloon

Abstract

Coronary thrombosis and secondary embolization remain two of the major challenges of intervention in myocardial infarction. Pharmacological dissolution as well as instruments to evacuate the thrombotic mass with or without distal protection have been applied in the acute interventions with variable degrees of success. With time, cross-linking of the fibrin strands results in a resilient, partially organizing coagulate that is more or less attached to the wall of the artery. The currently used devices designed to cope with recently formed thrombus may fail to disrupt these flexible structures, and pharmacological dissolution is also usually ineffective. Here, we report a case with a subacute occlusion; after failure of thrombus extraction, mechanical comminution of a clot with cutting balloons was successfully performed.