Mechanical Aspiration of a Heavy Thrombus in the Left Anterior Descending Artery using Penumbra Aspiration Catheter

Case Report

Austin Cardio & Cardiovasc Case Rep. 2023; 8(2): 1057.

Mechanical Aspiration of a Heavy Thrombus in the Left Anterior Descending Artery using Penumbra Aspiration Catheter

Ubaid Khan¹; Adnan Raufi²; Diaa Hakim³*

¹School of Medicine, King Edward University, Lahore, Pakistan

²Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA

³Department of Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA

*Corresponding author: Diaa Hakim, MD, PhD, FESC Brigham and Women’s Hospital, 1620 Tremont Street, Boston, MA, 02120, USA. Tel: (617) 732 4860 Email: [email protected]

Received: June 20, 2023 Accepted: July 24, 2023 Published: July 31, 2023


Left anterior descending artery thrombosis is a medical emergency that requires prompt intervention to achieve the best possible clinical outcomes [1]. Early recanalization of obstructed vessels and thrombectomy with subsequent stenting effectively restore blood flow and improve procedural outcomes [2]. However, Manual Aspiration Thrombectomy (MAT) using a flexible aspiration catheter is also an alternative method that can be used to open blocked vessels [3]. Recent advancements in aspiration catheters have improved their trackability and size, making them comparable in efficacy to SBT [4]. As a result, Stent-Based Thrombectomy (SBT) and mechanical aspiration thrombectomy have become the primary treatment options for endovascular therapy in particular cases of coronary artery disease. The concurrent utilization of SBT and MAT as first-line and fallback interventions has been demonstrated to be effective in restoring vascular recanalization [5].

Besides SBT and MAT, a new aspiration catheter device has emerged. It is a relatively new technique for treating a thrombus in LAD that involves using a specialized catheter to remove the blood clot from the culprit artery [6]. This minimally invasive procedure is faster and more effective than traditional treatments such as thrombolytic therapy or Percutaneous Coronary Intervention (PCI) [7]. Penumbra medical technology company (Penumbra Inc, Alameda, CA, USA) introduced the Aspiration System in 2014 [8]. This system is specifically designed to remove blood clots from veins and arteries in the "peripheral vasculature" as well as for the treatment of "pulmonary embolism" [9]. The CAT family of catheters, developed by Penumbra, is known for its robustness, trackability, and atraumatic design, making it well-suited for peripheral anatomy where a thrombus forms [10]. The system comes equipped with the "Penumbra ENGINE aspiration source," which can administer almost untainted and consistent vacuum to catheters. This proficiency enables the extraction of thrombus in vessels of assorted dimensions.

Recently, a penumbra aspiration catheter was used in a case report to remove thrombosis in acute coronary syndrome. According to the findings presented in this case report, it can be deduced that the Penumbra CAT RX catheter represents a secure and remarkably efficient alternative for eliminating blood clots in urgent scenarios. Notably, this method mitigates the heightened vulnerability to stroke often associated with the conventional approach of manual aspiration thrombectomy [11]. Previously, penumbra reperfusion catheter and MAT have been used as a "first-line therapy," and SBT with a "Solitaire stent" as a rescue therapy since 2012. This approach showed promising results regarding vessel recanalization and clinical outcomes [12].

Case Report

A 45-year-old male with a medical history significant for type 2 diabetes mellitus, hyperlipidemia, hypertension, and chronic heavy cigarette smoking was admitted to the hospital with a complaint of chest pain lasting for one day. Upon admission, an Electrocardiogram (ECG) showed T-wave inversion in leads V1-V3, and hs-Troponin was elevated. An echocardiogram was performed, which revealed significant hypokinesia in the anteroseptal walls. The decision was made to undergo cardiac catheterization to investigate the patient's condition further.

Coronary angiography showed a large caliber ectatic Left Anterior Descending (LAD) artery occluded by a thrombus (Figure 1). Despite difficulties wiring the LAD, the involved segment was successfully ballooned escalated, restoring TIMI-3 flow. An ectatic segment that is just distal to the involved segment was also noted, studded with a thrombus, resulting in a very hazy picture. Although attempts were made to aspirate the thrombus using an Export catheter (Medtronic, MN, USA), it was unsuccessful. The decision was then made to medically manage the patient for 24-48 hours before attempting the procedure again.