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The emergence of mechanical thrombectomy; a clot burden reduction approach
1Department of Cardiology, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana 70121, USA.
Insights
Intracoronary thrombi increase procedural risks. Mechanical devices like the Possis AngioJet and ultrasound thrombolysis effectively and safely remove coronary thrombi before intervention.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Intracoronary thrombi are associated with higher procedural complication rates during percutaneous revascularization.
- Existing pharmacologic and mechanical strategies for coronary thrombus management have varying efficacy.
Purpose of the Study:
- To review current pharmacologic and mechanical approaches for treating intracoronary thrombi before percutaneous coronary intervention.
- To evaluate the safety and effectiveness of specific mechanical devices for thrombus removal.
Main Methods:
- Review of pharmacologic treatments including thrombolysis and platelet IIb/IIIa inhibitors.
- Analysis of mechanical interventions such as balloon angioplasty, stenting, atherectomy, thromboaspiration (Possis AngioJet, hydrolyser), and ultrasound disintegration.
Main Results:
- Platelet IIb/IIIa inhibitors consistently reduce procedural complications and major cardiovascular events.
- Mechanical methods, including the Possis AngioJet and ultrasound thrombolysis devices, demonstrate high effectiveness and safety in removing coronary thrombi.
- Thrombolysis prior to percutaneous coronary intervention has shown mixed results.
Conclusions:
- Mechanical approaches, particularly thromboaspiration and ultrasound disintegration, offer a safe and effective strategy for managing intracoronary thrombi.
- These devices can mitigate procedural risks associated with percutaneous revascularization in patients with coronary thrombus.
Abstract:
Intracoronary thrombi are harbingers for increased procedural complications after percutaneous revascularization techniques. Current approaches to treat coronary thrombus prior to plaque intervention are pharmacologic and mechanical. Whereas the use of coronary thrombolysis prior to or during percutaneous coronary intervention have yielded mixed results, the group of the platelet IIb/IIIa inhibitors have uniformly been shown to decrease the procedural complications and the 30 day rate of major cardiovascular events. Mechanical approaches to managing thrombus include: compression with balloon angioplasty or stenting, removal with atherectomy devices, thromboaspiration with the Possis AngioJet and hydrolyser, and vibration disintegration with the ultrasound thrombolysis device. Recent clinical trials have shown that the Possis AngioJet and the ultrasound thrombolysis device are highly effective and safe for removing coronary thrombi prior to coronary intervention.