case_images: PMC6956446_01
case_images: A - Left ventricular thrombus (arrow), B - intracoronary thrombus after wire crossing (arrow), C - aspiration thrombectomy (arrow), D - macroscopically visible thrombus aspirated from the vessel, E - residual thrombus (arrow) in the distal part of the right coronary artery, F - hematoxylin and eosin staining of intracoronary thrombus showing extensive neutrophil infiltration (arrow), G - signs of clot retraction (arrow) suggestive of older age of thrombus
case_images: PWKI-15-38762-g001.jpg
case_images: PMC6956446_01_PWKI-15-38762-g001.jpg
case_images: f0001
case_images: Pre-procedural transthoracic echocardiography (TTE) showed mildly depressed left ventricular (LV) systolic function with hypokinesis of the inferior wall and presence of a well-organized thrombus attached to apical segments of LV (28 x 21 mm) (Figure 1 A). The occlusion was crossed with a Balance Middleweight guide wire (Figure 1 B) and the thrombus was aspirated using an Export thrombectomy catheter (Figure 1 C). The aspirated thrombus (Figure 1 D) was then stored in neutral buffered formalin and PolyTransport buffer. Promus Element stent was implanted in the lesion and post-dilated with a 4.0 x 15 mm non-compliant balloon, leading to complete restoration of the patency of the vessel with a small distal residual thrombus (Figure 1 E). Prolonged ECG monitoring showed no proof of atrial fibrillation. The histopathologic examination, which comprised standard hematoxylin and eosin staining, showed a complex structure, characterized by hypocellular retracted fibrin conglomerate, partially infiltrated with neutrophils (Figures 1 F and G).