Improvised mother-in-child aspiration with a multipurpose catheter for refractory coronary high thrombus burden: a case report.

Background: High thrombus burden (HTB) in acute myocardial infarction is associated with adverse outcomes, including no-reflow and distal embolization. Conventional thrombectomy techniques combined with other interventions (balloon dilatation, intracoronary thrombolytics, cutting balloon) may fail to adequately manage refractory thrombus. In the instance of a lack of interventional consumables, HTB becomes even more challenging. Case Description: We present two cases with massive proximal right coronary artery (RCA) thrombus [thrombolysis in myocardial infarction (TIMI) thrombus grade 5]. Initial attempts using thrombus aspiration catheters, balloon angioplasty, cutting balloon, and intracoronary thrombolysis were ineffective. Subsequently, a novel approach was then employed using a 120 cm 5F multipurpose angiographic (MPA) catheter in combination with guiding catheter to form a "mother-in-child catheter" configuration. Using balloon-assisted tracking technique, the MPA catheter was advanced to the thrombus location for direct aspiration. Successful thrombus removal was achieved, which facilitated optimal stent deployment and resulted in the restoration of final TIMI flow grade 3. No major adverse cardiovascular events occurred during follow-up. Conclusions: These two cases verify that the improvised MPA catheter-based direct thrombus aspiration represents a highly feasible, effective, and low-cost rescue approach for refractory coronary HTB when conventional thrombectomy methods are insufficient. This technique is especially valuable in catheterization labs lacking specialized thrombectomy equipment, providing a practical and accessible solution for complex high thrombus load coronary interventions.