Successful extraction of refractory thrombus from an ectatic coronary artery using stent retriever during primary angioplasty for acute myocardial infarction: a case report

BACKGROUND: Ectatic coronary segments are nidi for thrombus formation due to altered flow dynamics and stasis—an important component of Virchow’s triad. Ectasia accompanied by an adjacent coronary stenosis with or without a plaque event can lead to acute myocardial infarctions complicated by huge thrombus burden. CASE SUMMARY: Here, we present a case of a young male with acute inferior wall myocardial infarction complicated by Type IV coronary artery ectasia of the right coronary artery and huge thrombus burden that was refractory to conventional methods of thrombus management like thrombo-suction and intracoronary cocktails including tenecteplase. After a stormy course of transient complete heart block and recurrent ventricular tachycardia, the thrombus was successfully extracted using a stent retriever to achieve thrombolysis in myocardial infarction (TIMI) II plus flow distally. The lesion just distal to the ectasia was stented 24 h later to achieve TIMI III flow and the patient had an uneventful recovery subsequently. DISCUSSION: Angiographically visible thrombus that is refractory to intracoronary medications and aspiration thrombectomy can be successfully managed using a stent retriever.