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Thrombectomy and acute myocardial infarction

A 45-year-old woman presented hypotensive to the emergency department with an acute, inferoposterior myocardial infarctionwith right ventricular involvement. Shewas emergently taken for a primary angioplasty. As suspected, she had an occlusion to her proximal right coronary artery (Fig. 1a, arrow). With passage of the guidewire only, thrombolysis in myocardial infarction (TIMI) grade 1 flow was established, with angiographic evidence of a large thrombus load seen (Fig. 1b, arrow). An Export Thrombectomy Catheter (Medtronic, Minneaopolis, MN, USA) was inserted, which removed a large amount of thrombus (Fig. 1c). Subsequently, brisk TIMI grade 3 flow was reestablished, with no angiographic evidence of thrombus remaining (Fig. 1d). The minor remaining plaque was direct stented with a good final result. Thrombectomy catheters with distal protection have recently been shown to be of no benefit in ‘all-comers’ presenting with an ST segment elevation myocardial