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Acute thrombotic-ischemic coronary syndromes: the usefulness of TEC
1Interventional Cardiovascular Laboratories, Division of Cardiology, McGuire VA Medical Center, and Cardiac Catheterization Laboratories, Medical College of Virginia Hospitals, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA.
Insights
Transluminal extraction catheter (TEC) removes thrombus and plaque simultaneously for coronary artery disease. Careful technique and patient selection are crucial for successful outcomes, often requiring adjunct stenting.
Area of Science:
- Interventional Cardiology
- Cardiovascular Devices
- Medical Technology
Background:
- Atherosclerotic and thrombotic lesions in coronary arteries and saphenous vein grafts cause ischemic syndromes.
- Percutaneous coronary intervention (PCI) is a primary treatment modality.
- Limitations exist for pharmacologic thrombolytics and GPIIb/IIIa inhibitors in some patients.
Abstract:
Transluminal extraction catheter (TEC) is a percutaneous device that performs simultaneous thrombus aspiration and plaque excision. Clinical indications for its application are acute myocardial infarction, unstable angina, and stable angina caused by atherosclerotic, thrombotic lesions located within native coronary arteries and degenerated saphenous vein grafts. The device is useful in management of ischemic patients with contraindications to either pharmacologic thrombolytics or platelet GPIIb/IIIa receptor inhibitors, and can also effectively be used in combination with these agents. A successful TEC procedure requires careful patient selection, strict adherence to recommended indications, optimal equipment selection, familiarity with mechanical components of the device, full understanding of safe and efficacious techniques for deployment and activation, as well as recognition of unique associated angiographic manifestations such as the "empty-pouch phenomenon." As with other debulking devices, the incidence of restenosis post-TEC appears to be directly related to acute luminal gain at the time of procedure and therefore requires the need for adjunct stenting. This communication describes and illustrates various clinical, technical, and angiographic aspects of TEC procedure in patients with acute ischemic-thrombotic coronary syndromes. Cathet. Cardiovasc. Intervent. 48:406-420, 1999.