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Archives of cardiovascular diseases
Volume 105, n° 11
pages 616-618 (novembre 2012)
Doi : 10.1016/j.acvd.2011.07.006
Received : 10 June 2011 ;  accepted : 23 July 2011
Abciximab for distal thromboaspiration catheter-related embolization in ST-segment elevated myocardial infarction
Intérêt de l’abciximab pour l’embolisation coronaire distale liée au cathéter de thrombectomie dans l’infarctus du myocarde
 

Edouard Gerbaud , Benjamin Seguy, Pierre Coste
Soins intensifs cardiologiques-plateau de cardiologie interventionnelle, CHU de Bordeaux, 5, avenue de Magellan, 33604 Bordeaux Pessac cedex, France 

Corresponding author.

Keywords : Abxicimab, Thromboaspiration, Coronary embolization, ST-elevated myocardial infarction

Mots clés : Abciximab, Thrombectomie, Embolisation coronaire, Infarctus du myocarde (sus-décalage du segment ST)

Abbreviations : LCx, STEMI, TIMI


A 48-year-old woman was referred to our department with an inferolateral STEMI (Figure 1A). She received pretreatment with aspirin, a prasugrel loading dose (60mg) and intravenous administration of 0.5mg/kg enoxaparin.



Figure 1


Figure 1. 

Panel A. Initial electrocardiogram (ECG) showing inferolateral ST-segment elevation with ST-segment depression in the anterior leads. Panel B. At admission to the intensive care unit after angioplasty, ECG showed minor persistent ST-segment elevation (0.1mV) in the inferolateral leads. Panels C and D. One hour later, we observed the onset of an accelerated idioventricular rhythm followed by ST-segment normalization.

Zoom

Coronary angiography revealed proximal thrombotic occlusion of the LCx, without collateral flow (Figure 2A, Appendix B). An intracoronary abciximab bolus (0.25mg/kg body weight) was given immediately after the diagnostic angiograms. Thrombectomy with a dedicated catheter resulted in proximal reperfusion, however, distal embolization occurred (Figure 2B, Appendix B). Despite multiple attempts at thromboaspiration, the distal thromboembolus remained (Figure 2C, Appendix B). The patient underwent direct stenting of the proximal LCx with a bare-metal stent (Figure 2, Appendix B). Continuous abciximab infusion at 0.125 mcg/kg per min was given for 12hours. At admission to the intensive care unit, the patient’s chest pain had resolved and an electrocardiogram showed minor persistent ST-segment elevation (0.1mV) in the inferolateral leads (Figure 1B). One hour later, we observed the onset of an accelerated idioventricular rhythm followed by ST-segment normalization (Figure 1). Troponin Ic was raised to 76ng/mL (normal ≤ 0.04ng/mL). Five days later, repeat coronary angiography confirmed complete resolution of the thrombus with TIMI 3 flow in the LCx (Figure 2F, Appendix B).



Figure 2


Figure 2. 

Panel A. Coronary angiography revealed proximal thrombotic occlusion of the left circumflex coronary artery (LCx), without collateral flow. Panel B. An intracoronary abciximab bolus (0.25mg/kg body weight) was given immediately after the diagnostic angiograms. Thrombectomy with the export aspiration catheter (Medtronic Corporation, California, USA) resulted in proximal reperfusion, however, distal embolization occurred. Panel C. Despite multiple attempts at thromboaspiration, the distal thromboembolus remained. Panel D. The patient underwent direct stenting of the proximal LCx with a bare-metal stent. Panel E. Thrombolysis in myocardial infarction (TIMI) grade flow was zero in the distal LCx. Panel F. Five days later, repeat coronary angiography confirmed complete resolution of the thrombus with TIMI 3 flow in the LCx.

Zoom

This case highlights that despite adequate pretreatment, intracoronary abciximab and thrombectomy, distal embolization can occur in STEMI. An abciximab bolus and particularly subsequent infusion may be useful for treating distal thromboaspiration catheter-related embolization.

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.


Appendix B. Supplementary material

Click here to download the file (986 Ko)
 Video 1 
Video 1. 

Coronary angiography revealed proximal thrombotic occlusion of the left circumflex coronary artery (LCx), without collateral flow.

Click here to download the file (1.04 Mo)
 Video 2 
Video 2. 

Thrombectomy with the export aspiration catheter (Medtronic Corporation, California, USA) resulted in proximal reperfusion, however, distal embolization occurred.

Click here to download the file (3.96 Mo)
 Video 3 
Video 3. 

Despite multiple attempts at thromboaspiration, the distal thromboembolus remained.

Click here to download the file (1.39 Mo)
 Video 4 
Video 4. 

The patient underwent direct stenting of the proximal left circumflex coronary artery (LCx) with a bare-metal stent. Thrombolysis in myocardial infarction (TIMI) grade flow was zero in the distal LCx.

Click here to download the file (1.77 Mo)
 Video 5 
Video 5. 

Five days later, repeat coronary angiography confirmed complete resolution of the thrombus with thrombolysis in myocardial infarction (TIMI) 3 flow in the LCx.



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