Rheolytic thrombectomy with the Possis AngioJet: technical considerations and initial clinical experience

Percutaneous revascularization of thrombus-containing lesions has an increased incidence of adverse events such as abrupt vessel closure, periprocedural myocardial infarction and death. Various pharmacologic and mechanical approaches have demonstrated modest angiographic success with significant periprocedural complications. The AngioJet (Possis Medical, Inc., Minneapolis, Minnesota) is a dual lumen catheter that uses the principle of rheolytic thrombectomy to remove unorganized thrombus. A previously unreported scoring system based on clinical and angiographic data may help to select patients most likely to benefit from AngioJet treatment. When compared with urokinase in the randomized VeGAS 2 Trial, AngioJet therapy yields greater angiographic success with a lower incidence of 30-day major adverse events. Technical considerations and complications are reviewed in detail.