1. Migration of a thrombus
in coronary arteries
Sakhov O.S., Kenzhebaev A.M., Mukanov S.M.
City Heart Center, Almaty, Kazakhstan

2. History
Patient I., female, 69 y.o.
Risk factors: dyslipidemia
Diagnosis: STEMI
Chest pain with 5 hours duration, without
previous coronary anamnesis
ECG: 4 mm ST elevation in anterior leads
Troponin: 0,352 ng/ml

3. Coronaroangiography:
LAD – occlusion of ostium.
Cx – no significant stenosis
RCA - dominant, no stenosis.
A. intermediate – stenosis (40%) in proximal segment.

4. Primary PCI
Right femoral access. Guiding catheter 6 Fr JL 4.0.
The occlusion was easily crossed using a 0.014” BMW guidewire.
Predilation with a 2.0x15mm Sprinter balloon at 12atm.
Antegrade filling of the distal segment LAD (TIMI 2).

5. Stenting of infarct-related artery
Diagonal branch was not protected.
Stent Cypher Select 3.0x23mm was implanted at 18 atm.

6. Result
• Good angiographic effect, DB is not occluded
• But patient had intensive chest pain
• Analysis of the previous series showed that the intermediate
artery was occluded after 1st balloon inflation in the LAD.
•2nd guide wire crossed trough the occlusion and performed pre-
dilatation of proximal segment of intermediate artery.

7. New lost artery
Patency of the a.intermediate was restored.
Now was occluded distal segment of obtuse marginal.
Several balloon dilatations were performed without improvement
of distal flow. Intervention was stopped.
Patient was discharged on the 4th day in stable condition.

8. Resume:
 Migrationof a thrombus is dangerous complication
with the risk of new MI.
 Duringthe PCI, the operator's attention should be
not only in the occluded artery.
 Using of aspiration catheter could reduce the risk of
this complication.