Letter to the Editor Iliac artery thrombosis after aortic balloon counterpulsation: Treatment with intraarterial Tirofiban, manual thrombectomy and stenting Gianluca Rigatelli * , Massimo Giordan, Paolo Cardaioli, Lorenza Maronati, Beatrice Magro, Loris Roncon, Pietro Zonzin Interventional Cardiology Unit, Rovigo General Hospital, Rovigo, Italy Received 18 July 2005; accepted 25 July 2005 Available online 27 October 2005 Vascular complications after aortic balloon pumping include vascular thrombosis, arterial dissection, arterial perforation, and acute inferior limb ischemia [1]. Standard treatments of arterial thrombosis currently are thrombolysis and angioplasty [2]. We present the case of a 73-year-old man with typical anginal pain and angiographic evidence of severe left main and posterior interventricular artery disease, and left ventricular dysfunction requiring emergent aortic balloon pumping and immediate referral to the surgical room for a triple vessel aorto-coronary bypass. The patient had a difficult recovery with low output syndrome requiring a quite long counterpulsation. Few weeks after discharging, the man was admitted to our center for an non-ST elevation-acute coronary syndrome, mild sideropenic ane- mia and leg pain requiring immediate coronary angiogra- phy and aggressive drugs therapy including Tirofiban (0.25 ml/kg). An early ostial occlusion of the venous graft for the right coronary artery not susceptible of recanalization was demonstrated in the cath lab: a final aortoiliac angiography demonstrated a thrombotic occlusion of the right common iliac artery (Fig. 1A). Thus, in order to avoid the risk of bleeding, we decide to do not proceed with thrombolysis but to infuse Tirofiban and haeparin 25.000 UI/24 h through the 6F right artery femoral sheath with a high dose bolus of 0.5 mg/kg and maintenance dose of 18 ml/kg. The patients underwent 24 h after an angiographic control: the right common iliac artery appeared patent with a quite large amount of thrombus (Fig. 1B). A manual thromboaspiration through a 7F 23 cm sheath was performed with retrieval of thrombotic material (Fig. 1C), improvement of the flow. Angioplasty with 7.0 Â 20 mm OptaPro angioplasty balloon (Cordis Europa N.V., Roden, The Netherlands) was performed (Fig. 1D) and a tight stenosis of the proximal common iliac artery was evidenced (Fig. 1E) and final stenting with 7.0 Â 29 mm Palmaz Genesis stain-steel stent (Cordis Europa N.V., Roden, The Netherlands) was accomplished re-establishing an excellent final result (Fig. 1F). The patient was discharged 3 days later on medical therapy with non-thoracic or leg pain. Tirofiban therapy has been suggested as an alternative or adjunctive therapy for acute arterial ischemia [3,4] but its use followed by manual thromboaspiration and stenting in patients with arterial thrombosis due to long-term aortic balloon counterpulsation was not previously reported: this strategy can be employed in patients in which thrombolysis cannot be performed for relative or absolute contraindication. References [1] Sirbu H, Busch T, Aleksic I, Friedrich M, Dalichau H. Ischaemic complications with intra-aortic balloon counter-pulsation: incidence and management. Cardiovasc Surg 2000;8:66 – 71. [2] Meharwal ZS, Trehan N. Vascular complications of intra-aortic balloon insertion in patients undergoing coronary revascularization: analysis of 911 cases. Eur J Cardiothorac Surg 2002;21:741– 7. [3] Shlansky-Goldberg R. Platelet aggregation inhibitors for use in peripheral vascular interventions: what can we learn from the experience in the coronary arteries? J Vasc Interv Radiol 2002;13: 229 – 46. [4] Burkart DJ, Borsa JJ, Anthony JP, Thurlo SR. Thrombolysis of acute peripheral arterial and venous occlusions with tenecteplase and eptifibatide: a pilot study. J Vasc Interv Radiol 2003;14:729–33. 0167-5273/$ - see front matter D 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2005.07.072 * Corresponding author. Via Tito Speri, 18, 37040 Legnago, Verona, Italy. Tel./fax: +390 44220164. E-mail address: jackyheart@hotmail.com (G. Rigatelli). International Journal of Cardiology 112 (2006) 387 – 388 www.elsevier.com/locate/ijcard