Transradial extra deep coronary intubation with a guide catheter for direct thromboaspiration in acute myocardial infarction

Deep coronary intubationwith a guide-catheter may help especially in cases of stent delivery failure in the presence of calcified and/or tortuous arteries during percutaneous coronary intervention [1,2]. In this report, we present a case where the aspiration device failed due to the presence of a large thrombus burden; therefore, direct thromboaspiration was performed following an extra deep intubation of a 6-Fr guidecatheter via the transradial approach. A 63-year old gentleman was admitted to a community hospital because an acute myocardial infarction. On history, he had a severe and long lasting chest pain episode before the admission, and an ECG showed new Q-waves with ST-elevation in inferior leads. Although he was initially treated medically, he was with hypotension and continued having “on–off” chest pain episodes; thus, he was referred to our tertiary care center for cardiac catheterization. Coronary angiography was performed via the right radial approach and showed no significant obstructive lesions in the left coronary artery, and a right coronary artery (RCA) with a 70% proximal stenosis and a 100% mid-distal thrombotic occlusion (Fig. 1A). We therefore decided to intervene percutaneously; hence, after engaged the RCA with a 6-Fr Barbeau Vista-Long-Brite-Tip (Fig. 1B) guide-catheter (Cordis Corp, Miami Lakes, FL) and easily crossing the obstruction with a BMW