Reperfusion With Thrombectomy after poiled primary balloon Angioplasty in Acute Myocardial Infarction

Primary percutaneous coronary interventions were used in patients with acute myocardial infarction especially with altered hemodynamic parameters for over 20 years. Although conventional percutaneous interventions are more effective and perform reperfusion faster than thrombolytic therapy, propagation or embolisation of the thrombus to distal coronary arteries may decrease the success. In this report, 78 years old woman with inferior myocardial infarction, right ventricular infarction and cardiogenic shock was presented. She was immediately taken in catheter laboratory at the third hour of the chest pain because of hemodynamic alteration. The coronary angiography showed that, the right coronary artery was totally occluded in the middle and there was no distal antegrad flow. There was also serious obstructions in circumflex and left anterior descending arteries. The obstruction in the right coronary artery was crossed with a guidewire and in spite of multiple balloon inflations, angioplasty was unsuccessful because of thrombus. With X-sizer thrombectomy device, thrombus was extracted and TIMI-III flow was restored. After the thrombectomy, a residual obstruction remained and a dissection that did not limit the flow appeared. For this reason stent implantation was done. After this procedure hemodynamic and clinical parameters were quickly improved. One week later, the stenosis in the left anterior descending artery was treated with baloon angioplasty and stent implantation. One week after the second intervention, she was discharged with improved general condition.