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Thrombectomy with AngioJet catheter in native coronary arteries for patients with acute or recent myocardial
Y Nakagawa1, S Matsuo, T Kimura
1Kokura Memorial Hospital, Kitakyushu, Japan.
Insights
The AngioJet thrombectomy catheter safely and effectively removes coronary artery thrombus in patients with myocardial infarction (MI). This procedure improves blood flow and allows for uncomplicated subsequent stenting, with acceptable restenosis rates.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- Myocardial infarction (MI) is frequently associated with intracoronary thrombus, a known risk factor for poor outcomes after percutaneous transluminal coronary angioplasty.
- The efficacy and safety of the AngioJet thrombectomy catheter for acute or recent MI in native coronary arteries remain unclear.
Purpose of the Study:
- To evaluate the efficacy and safety of the AngioJet thrombectomy catheter for thrombus removal in patients with acute or recent myocardial infarction.
- To assess the impact of AngioJet thrombectomy on coronary artery blood flow and the feasibility of subsequent interventions.
Main Methods:
- Retrospective analysis of 31 patients with acute or recent MI undergoing AngioJet thrombectomy in native coronary arteries.
- Assessment of procedural success, adjunctive procedures (balloon angioplasty, stenting), and Thrombolysis In Myocardial Infarction (TIMI) flow grading.
- Follow-up angiography at 3 to 6 months to evaluate restenosis rates.
Main Results:
- High procedural success rate (94%) for AngioJet thrombectomy.
- Significant improvement in TIMI flow grading post-thrombectomy (0.70 to 2.61, p < 0.0001) and after adjunctive procedures (2.84).
- Low in-hospital and follow-up event rates; acceptable restenosis rates (21% overall, 8% in stented patients).
Conclusions:
- The AngioJet thrombectomy catheter is safe and effective for removing coronary thrombus in MI patients.
- Thrombus removal facilitates safe and uncomplicated subsequent stenting.
- The device demonstrates a favorable safety profile and acceptable long-term outcomes for managing acute coronary thrombosis.
Abstract:
The AngioJet thrombectomy catheter removes thrombi by rheolytic fragmentation and suction. The purpose of this study was to identify the efficacy and safety of this new device. Myocardial infarction (MI) is associated with intracoronary thrombus. Intracoronary thrombus has been identified as a risk factor of unfavorable outcome after percutaneous transluminal coronary angioplasty. To what extent the AngioJet is applicable or effective for acute or recent MI in native coronary artery is not clear. Thrombectomy with the AngioJet was attempted in 31 patients with 31 native coronary arteries selected from 304 patients with acute or recent MI. Follow-up angiography was performed at 3 to 6 months. Procedure success was achieved in 29 patients (94%). Adjunctive balloon angioplasty was performed after AngioJet thrombectomy in 30 patients (97%), and in only 1 patient (3%) AngioJet thrombectomy was the sole procedure. Subsequent stenting after balloon angioplasty was attempted successfully in 12 patients (40%) without thrombotic complications. Thrombolysis In Myocardial Infarction trial flow grading increased from 0.70 +/- 0.97 before to 2.61 +/- 0.88 after AngioJet thrombectomy (p <0.0001), to 2.84 +/- 0.64 after adjunctive procedures (p = 0.070). At follow-up angiography restenosis rate was 21% but Thrombolysis In Myocardial Infarction flow 3 was present in all patients. The restenosis rate of stented patients was 8%. There were no major events during in-hospital and follow-up. The AngioJet can be used safely and successfully to remove thrombus from the native coronary artery of patients with MI. Thrombus removal makes subsequent stenting safe and uncomplicated. The restenosis rate was considered to be acceptable.