[A multi-device approach to an unusual case of left main thrombosis: when manual thrombectomy is not enough].

We report an unusual case of left main thrombosis with distal embolization in the left anterior descending coronary artery (LAD). Two filter wires were placed in both LAD and circumflex coronary arteries at the beginning of the procedure. Manual thrombectomy was performed but only a portion of the left main thrombosis was removed; residual debris was displaced into the distal LAD but captured by the filter. A loco-regional infusion of abciximab was finally administered by a microporous balloon in order to treat residual embolization in the distal LAD. This case shows that manual thrombectomy does not always allow for complete and safe removal of thrombotic material, especially when high-burden coronary thrombosis occurs in large, proximal vessels. A multi-device approach has proved useful in this patient, allowing to obtain complete resolution of luminal thrombosis.