Case report
ST-elevation myocardial infarction with local infusion of abciximab using thrombectomy catheter in a patient with very late stent thrombosis

A case of a 56-year-old male with a diagnosis of ST-segment elevation myocardial infarction caused by in-stent thrombosis in a previously impanted bare metal stent after discontinuation of aspirin is presented. On admission there were ST segment elevations in leads II, III, aVF with Q wave in III and aVF in the electrocardiogram. Three years before the admission patient had suffered from inferior wall myocardial infarction and was treated successfully with primary percutaneous coronary intervention (PPCI) of the right coronary artery with bare metal stent (BMS) implantation. Twelve months after the index PPCI patient stopped receiving all medications including ASA. He felt he was in good health condition and did not need to take medications any longer. For the next 2 years he had never visited doctor for follow-up visit. In current angiography occlusion of the right coronary artery with thrombus was identified. Patient was treated with aspiration thrombectomy which revealed large thrombus burden and with intralesion administration of bolus of abciximab via thrombectomy catheter. Afterwards PCI with drug eluting stent implantation was performed. Patient was discharged home after 5 days. At discharge his antiplatelet therapy consisted of acetylsalicylic acid (75 mg once daily) for life, and clopidogrel (75 mg once daily, for at least 12 months).