LAUSR

Background: Excimer Laser Coronary Atherectomy (ELCA) is a well-established adjunctive treatment modality that can be effectively used to reduce thrombus burden during percutaneous coronary intervention of coronary thrombosis. Case: A 34-year-old male with history of COVID-19 pneumonia one month prior, presented with non-ST elevation myocardial infarction. Coronary angiography revealed large thrombus burden involving the distal left main (LM) and ostial left anterior descending artery (LAD), as well as a distal LAD thrombotic occlusion (Figure 1A). Intravascular ultrasound showed distal LM plaque rupture with overlying thrombus (Figure 1C). Decision-making: Given the large thrombus burden and elevated risk of distal embolization, we proceeded with lesion passivation using adjunctive antiplatelet and antithrombotic treatment for 48 hours. ELCA was then used for thrombus debulking with a 1.7-mm catheter under distal embolic protection placed in mid LAD (Figure 1B). This was followed by aspiration thrombectomy, balloon dilation, and placement of a drug eluting stent in the distal LM and ostial LAD (Figure 1D). Conclusion: A strategy of using ELCA followed by stent implantation can be useful in selected patients with high intracoronary thrombus burden. ELCA can achieve effective thrombus removal, promotion of fibrinolysis, and platelet-stunning effects allowing plaque debulking and reduction of distal embolization. This case combines traditional tools to achieve the best possible outcome. [Formula presented]