A patient was referred for PCI of a RCA in-stent CTO. Crossing was successful with a CrossBoss catheter, but the artery had a large thrombus burden. Despite multiple balloon dilations, aspiration with Penumbra and an Export catheter and administration of eptifibatide and vasodilator significant amount of thrombus remained as confirmed by OCT. The patient was admitted and received 48 hours of heparin and eptifibatide, but unfortunately he continued to have large thrombus burden on repeat angiography. After using a Filterwire, several rounds of aspiration with a Penumbra and through a guide extension, laser, multiple balloon dilations, use of the Solitaire X thrombus retriever (indicated for stroke interventions) and stenting the thrombus burden decreased and antegrade flow was restored. The patient had an uneventful recovery.
