A 46 year-old man with a history of hyperlipidemia was admitted with acute anterior ST-segment elevation MI and his ejection fraction was 30%.  He had rest typical chest pain despite routine and complete medical treatment. Urgent coronary catheterization revealed complete occlusion in the proximal of LAD artery with bulky thrombosis (TIMI flow =0-1). Complete   thrombosuction and primary PCI was not possible. Urgent three graft CABG was done due to symptoms of patient and unsuccessful PCI.

Total lumen of LAD and diagonal arteries were full of clot. Large and tubular clots of LAD and diagonal were removed with endarterectomy spatula, irrigation with heparinized saline and retrograde coronary perfusion via coronary sinus catheter. Postoperative period was uneventful.

This patient was very rare case due to intracoronary thrombectomy via surgery and also due to   bulky and large clot that involved all way of coronary arteries. Similar cases were not found in different literatures. 

SOURCE: URMIA MED J 2016: 26(12): 1094 ISSN: 1027-3727