"Fogarty-like" removal of large coronary thrombus

In order to avoid distal embolization in patients undergoing emergency percutaneous coronary intervention for ST-elevation myocardial infarction, both thrombectomy and distal protection devices have been evaluated with conflicting effects on myocardial perfusion. However, the removal of massive coronary thrombus is always problematic, and failure of standard approaches might result in severe microvascular damage. We report a case of the unusual use, in a "Fogarty-like" fashion, of the Spider™ filter to trap and remove a large thrombus that was refractory to aspiration and balloon dilatation before stent implantation in a proximal, infarct-related coronary artery.