A Case of Thrombus Aspiration Catheter Trapped in Coronary Artery Due To Rupture of its Main Shaft and Twisting Over the Wire Cagdas Akgullu 1* , Ufuk Eryılmaz 1 , Hasan Gungor 1 , Cemil Zencir 1 , Mucahit Avcil 2 and Bekir Dağli 2 1 Department of Cardiology, Adnan Menderes University School of Medicine, Aytepemevkii Merkez/ Aydin, Turkey 2 Department of Emergency, Adnan Menderes University School of Medicine, Aytepemevkii Merkez/ Aydin, Turkey 3 Department of Biostatistics, Medical Faculty, Adnan Menderes University, Aydin, Turkey * Corresponding author: Cagdas Akgullu, Department of Cardiology, Adnan Menderes University, School of Medicine, 090100, Aytepe, Aydin / Turkey, Tel: +90256 444 12 56- 2215; Fax: +90 256 213 60 64; E-mail: cagdasakgullu@gmail.com Rec date: Mar 22, 2014; Acc date: May 02, 2014; Pub date: May 16, 2014 Copyright: © 2014 Akgullu Ç, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract We report a novel complication that arose while treating a 54 year old man with acute inferior ST elevation segment myocardial infarction. It was decided to perform thrombus aspiration prior to balloon angioplasty. However, after aggressive maneuvers to cross the tight lesion in order to suck the distal thrombus, a novel complication was encountered. The Thrombus Aspiration Catheter (TAC) got stuck in the coronary artery. When the whole apparatus was pulled out, it was realized that the guidewire cut the main shaft of TAC and catheter got twisted over the wire. To the best of our knowledge, this is the first report of a complication of this type. Keywords: Thrombus aspiration catheter; Complication; ST elevation segment myocardial infarction; Entrapment Introduction Due to the inherent advantages of thrombus aspiration in the treatment of ST Elevation Segment Myocardial Infarction (STEMI), there is a growing body of interest on thrombus aspiration devices [1-3]. As a result, there is a substantial increase in the utilization of Thrombus Aspiration Catheter (TAC) in catheterization clinics. This has led to the occurrence of peculiar complications in the field of percutaneous angioplasty. Here a case of a 54-year-old male patient, presented to our hospital with acute inferolateral STEMI, is being reported. Due to high thrombus burden the use of TAC was recommended; however due to aggressive manoeuvres while attempting to cross the lesion prior to angioplasty, a novel complication was encountered. To the best of our knowledge this complication has not been reported before. Case A 54-year-old man was presented to the university hospital with ongoing angina pectoris for the last 2 hours. He did not have any systemic illness or a history of coronary artery disease. Physical examination was found to be normal. The subject was hemodynamically stable with clear lungs and no observable cardiac murmurs, S3 or peripheral oedema. The initial electrocardiogram showed 3 mm of ST segment elevation in the inferior leads and 2 mm of ST segment depression in the anterior leads consistent with an acute inferior wall STEMI. He was treated with 5000 units of heparin intravenously, 300 mg of aspirin and clopidogrel (600 mg loading dose) at the emergency department. He was then immediately transferred to the coronary catheterization laboratory. Coronary angiography revealed the presence of a patent LMCA stent, 50% stenosis of the proximal segment of the Left Anterior Descending artery (LAD) and a poorly developed left-to-right collaterals (Rentrop grade 1), 30% and 75% stenosis in the proximal and middle segments respectively of the Left Circumflex Artery (LCX) and a 100% stenosis in the proximal segment of right coronary artery (RCA). Tirofiban infusion was started prior to angioplasty. The ostium of the right coronary artery was selectively cannulated by a 6 French 4.0 Judkins guide catheter. The lesion was crossed with a 0.014 non-hydrophilic PTFE coated intermediate guidewire (Alvimedical Neviguide ™ ) and TIMI grade 2 flow was observed immediately after with a high burden of thrombus spreading from proximal lesion to the acute margin segment of RCA (Figure 1). It was decided to perform thrombus aspiration and a VMAX ™ aspiration catheter was directed to the lesion. After suction of proximal thrombus, the proximal flow improved but distal embolization occluded the posterolateral branch. It was decided to perform distal suction as well, but after a few unsuccessful attempts to cross the proximal lesion, balloon angioplasty was performed with a 3.0×25 mm Maverick balloon (Boston Scientific) at a pressure of 8 atm at the proximal lesion. Another attempt was made to cross the lesion again with the thrombus aspiration catheter and it was difficult to cross the lesion due to the kink but managed to cross when pushed hard. It was also found difficult to cross the crux to distal posterolateral segment but eventually gave in when the TAC was pushed with increased pressure. After a few successful suction of the thrombus, it was decided to push it back to deploy the stent. However it was found impossible to move the guidewire in either direction. It was noticed at this point through the scope view, the separation of guidewire from the main shaft of TAC (Figure 2). It was decided to pull both the guidewire and the TAC out together, however the guiding catheter was stuck in the mid portion of RCA hence the guidewire and TAC did not move backwards. Then it was decided to pull the whole system out altogether. After a period of resistance, a sudden release occurred and the whole system was recovered successfully. The main shaft of the TAC was found ruptured from the guidewire starting from its back till its suction tip and the whole wire was twisted over the main shaft of TAC (Figure 3). Akgullu et al., J Clin Exp Cardiolog 2014, 5:5 DOI: 10.4172/2155-9880.1000309 Case Report Open Access J Clin Exp Cardiolog Preventative Cardiology ISSN:2155-9880 JCEC, an open access journal Journal of Clinical & Experimental Cardiology J o u r n a l o f C l i n ic a l & E x p e r i m e n t a l C a r d i o l o g y ISSN: 2155-9880