Guidewire Retrieval Device as Bailout for Massive Coronary Thrombus in STEMI

Background: Patients with ST-segment elevation myocardial infarction (STEMI) and massive thrombus burden (TIMI flow grade 5) remain challenging to manage. Conventional aspiration thrombectomy often fails to achieve adequate thrombus reduction. Case Summary: A 52-year-old man presented with recurrent right coronary artery occlusion 5 days after initial intervention for acute inferior STEMI. After failed conventional aspiration, a guidewire retrieval device (Lawnest) integrated with an aspiration catheter was employed as a bailout. Optical coherence tomography confirmed significant thrombus reduction from TIMI flow grade 5 to grade 3, enabling successful drug-eluting stent implantation. Discussion: This case demonstrates a novel bailout technique using a coronary-specific guidewire retrieval device integrated with aspiration catheter via a hemostasis valve for refractory massive thrombus when conventional thrombectomy fails. Take-Home Message: Coronary-specific guidewire retrieval devices can serve as bailout techniques for refractory massive thrombus when integrated with aspiration catheters to minimize distal embolization risk.