Thrombus capture by withdrawal of an open filter device: a useful treatment for large non-occlusive coronary thrombus.

Aims: The aim of this study was to assess the safety and feasibility of manual removal of a non-occlusive coronary thrombus using an open filter device. Between April 2006 and December 2011, 1,102 patients were treated percutaneously for acute coronary syndrome at our institution. Of these, nine (1%) had a large "cannon-ball" non-occlusive intracoronary thrombus, which did not improve with standard thrombectomy aspiration catheters. In these patients, we describe a novel technique of thrombus removal using the ev3 Spider™ filter device. Four patients had LAD thrombus, three had RCA thrombus, one LCX thrombus and one SVG thrombus. The primary endpoint of substantial or complete thrombus removal, prevention of no-reflow/slow flow phenomenon and achievement of TIMI 3 flow post stenting was achieved in all cases. Coronary dissection occurred in one case where the lesion was heavily calcified. There were no other complications related to the device. This is the first case series describing the use of the ev3 Spider™ filter device for the removal of a large intracoronary thrombus refractory to conventional treatment. This was associated with a high procedural success rate and may reduce the risk of no-reflow in these cases.