Distal Coronary Artery Thrombus After Primary PCI Resolved by Excimer Laser Coronary Angioplasty

BACKGROUND: Residual thrombus, a prognostic factor in ST-segment elevation acute myocardial infarction (STEMI), can be treated with excimer laser coronary angioplasty (ELCA). CASE SUMMARY: A 59-year-old man admitted with chest pain was diagnosed with STEMI. Emergency coronary angiography confirmed complete occlusion of the proximal right coronary artery. A stent was placed at the lesion site; angiography revealed a translucent thrombus in the distal right coronary artery. ELCA with a 0.9-mm probe, followed by 1.4-mm probe, was performed at maximum output with a backward pull. Subsequent angiography revealed improvements in the translucent image. DISCUSSION: In patients with STEMI, persistent residual distal coronary thrombus after primary percutaneous coronary intervention may negatively affect prognosis. Here, ELCA successfully resolved residual thrombus in the distal coronary artery. TAKE-HOME MESSAGE: ELCA may be considered in select cases with residual distal thrombus after primary percutaneous coronary intervention, particularly when the distal coronary artery is not tortuous.