Ostre zamknięcie dominującej prawej tętnicy wieńcowej leczone angioplastyką wieńcową z implantacją stentu lekowego oraz skuteczną trombektomią aspiracyjną masywnego zakrzepu u pacjentki z wywiadem wielogodzinnego nietypowego bólu w klatce piersiowej

62 year-old female, with several risk factors like hypertension, hyperlipidemia, smoking, presented with atypical chest pain that lasted for many hours before hospital admission and ST segment elevation in infero-postero-lateral leads. Her angiography revealed occlusion at the beginning of 3rd segment of the dominant right coronary artery (RCA). After guidewire crossing and initial manual aspiration thrombectomy passages, still a massive thrombus burden was present. Eptifibatide intracoronary bolus followed by intravenous infusion was administered and drug eluting stent was implanted to the RCA. After stent implantation distal migration of thrombi was noted, therefore further thrombectomy was performed. There were no signs of thrombotic element after flushing thrombectomy catheter, however, no blood flow from the guiding catheter was observed after opening the valve. Operators decided to remove guiding catheter and guidewire „en bloc”, after saline flushing massive thrombus was eventually found in the ramp. After re-engaging RCA with a new guiding catheter, TIMI 3 flow was present, with no signs of thrombi, the procedure was finished. After the PCI patient was free from angina, ST segment normalization was noted. On echocardiography LVEF was 43%, with a basal and mid inferior, posterior and basal-septal segments akinesis along with moderate mitral regurgitation. Because of pulmonary congestion patient needed more aggresive diuretic therapy, eventually with a good response and after 10 days of hospitalization she was discharged home.