ENVAST IN A STEMI WITH A MASSIVE THROMBOTIC BURDEN

PUBLICATION TITLE:
EnVast Mechanical Thrombectomy After Thrombus Aspiration Failure in a STEMI With a Massive Thrombotic Burden
Authors:
Dario Bongiovanni, Francesco Loizzi, Antonio Landi, Léa Utsch, Marco Araco, Michael Joner, Marco Valgimigli
Journal:
Journal of American College of Cardiology Foundation, JACC Cardiovascular Interventions, Jan 2023
Background:
The management of coronary lesions with large thrombotic burden still poses challenges in contemporary practice and remains associated with poor outcomes.
CASE PRESENTATION:
55 Y.O. overweight male patient presenting STEMI and ongoing angina for 24 hours. Coronary angiography documented diffuse coronary ectasia with thrombotic occlusion of the mid-right coronary artery.
PROCEDURE:

enVast was used as bail-out after

  • Balloon angioplasty : FAILED
  • Administration of intravenous tirofiban
  • 3 passes of aspiration: ABORTED each time due to complete lumen tip obstruction by thrombotic material

enVast was used 7 times, retrieving large thrombi in 5 passes

results:
  • Complete ST resolution
  • TIMI 3
  • No residual coronary narrowing after thrombectomy, so
    decision not to stent the vessel
  • Non–flow-limiting distal embolization was documented
HISTOLOGICAL ANALYSIS OF CLOTS REVEALED:
  • Predominantly red clots aspirated by aspiration
  • enVast extracted mixed thrombi with a significantly greater prevalence of platelets and connective tissue
Conclusions:
These insights suggest that enVast retrieved more complex and extensive thrombotic structures providing an improved thrombectomy. The thin lumen of thrombus aspiration devices may limit their applicability due to early blockage and hinder sufficient aspiration and thrombus removal. Therefore, in cases with massive thrombotic burden, enVast is a valuable option that enriches the interventional cardiologist’s toolbox.
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