A 65-year-old man presented with a non-ST-elevation acute coronary syndrome. His medical history was unremarkable. Apart from a brother, who sustained a myocardial infarction at the age of 40, no cardiovascular risk factors were present. Coronary angiography revealed normal left anterior descending and circumflex arteries. The right coronary artery was subtotally occluded with an extensive thrombus running into the posterolateral branch (figures 1A and B). Despite appropriate medical treatment, intermittent chest pain persisted. The patient underwent a percutaneous coronary intervention with mechanical removal of the thrombus by aspiration followed by balloon dilatation. During the 12 hours preceding this procedure a glycoprotein IIb/IIIa receptor antagonist was continuously infused, while aspirin, clopidogrel, and a low-molecular-weight heparin (LMWH) were also administered. The intervention was only partially successful with limited restoration of right coronary perfusion resulting in a TIMII flow. Following the procedure, intermittent chest pain persisted initially but subsided after a few days of continued administration of aspirin, clopidogrel and an LMWH.
