key: cord-1016948-0b4xgbx8
authors: Hanna, Elias B.; Rossen, James; Eustes, Alicia S.; Dayal, Sanjana
title: Heavy lone coronary artery thrombosis treated by stent retriever, in the setting of COVID‐19 infection
date: 2022-01-18
journal: Catheter Cardiovasc Interv
DOI: 10.1002/ccd.30084
sha: d64745325a7f64ab67fe20fe6faab5c958b41a8a
doc_id: 1016948
cord_uid: 0b4xgbx8

We present a case of heavy lone coronary thrombosis in the setting of COVID‐19 infection. We highlight the special angiographic, ultrasonographic, and histological features of this thrombus, and we describe the application of carotid stent retriever for its removal.

COVID-19 infection has been associated with a hypercoagulable state and vascular thrombi, 1-3 but the clinical and histological features of those thrombi in the coronary vasculature are poorly characterized. We present a case that illustrates the technical challenges of coronary intervention in this setting, as well as the specific histological features of these thrombi. The thrombi are sent for histopathological examination, which reveals the following: a high burden of neutrophil extracellular traps (NETs), but a lack of COVID-19-specific protein (using nucleocapsid antibody stain) (Figure 9 ).

In the coronary system, thrombectomy may be performed using one of the following two traditional techniques: (i) manual aspiration, which is limited by the small caliber of the suction catheters; (ii) or rheolytic thrombectomy (Angiojet), which uses high-pressure saline to create a vacuum at the tip of the catheter, thereby causing both thrombus fragmentation and suction. The stent retriever thrombectomy system has only been studied and approved for use in the intracranial circulation but proved to be essential in our case. 4 It is maneuvered as follows ( Figure 6 ): (i) the thrombus is crossed with a guidewire and a microcatheter, which is positioned distal to the thrombus; (ii) the guidewire is removed, and the stent retriever is advanced inside the microcatheter and unsheathed at the level of the thrombus, allowing it to deploy and integrate into the thrombus; (iii) a stent waist may initially be seen and is followed by progressive stent expansion into the thrombus; (iv) after a short time (typically 2-4 min) of stent-thrombus integration, the stent is withdrawn into the guide, 

This case highlights the special angiographic, ultrasonographic, and histological features of lone coronary artery thrombosis in the setting of COVID-19 infection, and the applicability of stent retriever for its removal. 

Coagulation abnormalities and thrombosis in patients with COVID-19

Supported by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up, JACC state-of-the-art review

Coagulopathy and antiphospholipid antibodies in patients with COVID-19

SWIFT PRIME Investigators. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke

Assessment of neutrophil extracellular traps in coronary thrombus of a case series of patients with COVID-19 and myocardial infarction

Heavy lone coronary artery thrombosis treated by stent retriever, in the setting of COVID-19 infection

This work was possible through funding from Department of Veterans Affairs I01CX001932 to S. D., a pilot funding from Carver College of Medicine, UI to S. D., and National Institutes of Health T32 HL007344 to A. S. E.

The authors declare that there are no conflict of interests.

The data that support the findings of this study are available from the corresponding author upon reasonable request.

http://orcid.org/0000-0002-0967-9115