Ultra-Deep Guide Catheter Intubation for Direct Thromboaspiration in Acute Myocardial Infarction.

Thrombus burden remains an important mortality risk factor during primary percutaneous coronary interventions (PCI), especially when associated with distal embolization of atheromatous debris (Sharma et al., 2016; Ibanez et al., 2018 [1,2]). Although routine thrombus aspiration during primary PCI in acute coronary syndrome (ACS) is not recommended (Sharma et al., 2016 [1]), some procedures become very challenging when thrombus removal and vessel reperfusion is not achieved with conventional dedicated devices. We describe a case of a 60-year old man with a late-comer infero-lateral ST-segment elevation myocardial infarction (STEMI) undergoing right coronary artery primary PCI. A high thrombotic burden was shown requiring an ultra-deep guide catheter intubation to perform a successful thromboaspiration and stenting.