A sequential approach to the management of a massive intracoronary thrombus in ST elevation myocardial infarction: a case report.

Thrombus-laden coronary lesions present a particular challenge to the interventional cardiologist. Despite the development of multiple strategies to attack this problem, lesions with angio-graphically visible thrombus still carry a high risk of complications when coronary intervention is attempted. The authors present a case of acute inferior ST elevation myocardial infarction with a massive thrombus in an ectatic right coronary artery. Sequential treatment with intra-coronary glycoprotein IIb/IIIa inhibitor, rheolytic thrombectomy with 2 different-sized catheters, and transcatheter thrombus aspiration with a Pronto aspiration catheter was required to achieve a satisfactory result. This case illustrates the potential benefit of combining various mechanical strategies to treat intracoronary thrombus.