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Published on: January 18, 2018
Rheolytic thrombectomy during percutaneous revascularization for acute myocardial infarction: experience with the
Insights
Mechanical thrombectomy using AngioJet effectively clears thrombus in acute myocardial infarction (MI) patients, enabling successful immediate treatment and improving coronary blood flow (TIMI flow). This approach reduces complications associated with thrombus during interventions.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Medical Devices
Background:
- Acute myocardial infarction (MI) interventions are complicated by thrombus, leading to reduced coronary flow and distal embolization.
- Mechanical thrombectomy devices offer a potential solution to mitigate these complications.
Purpose of the Study:
- To evaluate the safety and efficacy of AngioJet rheolytic thrombectomy as an adjunctive treatment for acute MI with significant thrombus.
- To assess angiographic and clinical outcomes following rheolytic thrombectomy and immediate definitive treatment.
Main Methods:
- Seventy patients with acute MI and angiographically evident thrombus underwent AngioJet rheolytic thrombectomy followed by definitive treatment.
- Angiographic outcomes included residual stenosis and Thrombolysis in Myocardial Infarction (TIMI) flow.
- Clinical outcomes assessed procedure success, clinical success, and in-hospital mortality.
Main Results:
- Procedure success was achieved in 93.8% and clinical success in 87.5% of patients.
- AngioJet significantly reduced thrombus area (P <.001) and improved final TIMI 3 flow in 87.7% of patients.
- In-hospital mortality was 7.1%, with low rates of procedural complications like distal embolization and perforation.
Conclusions:
- Rheolytic thrombectomy with AngioJet is a safe and effective method for treating acute MI patients with thrombus-containing lesions.
- This technique facilitates immediate definitive treatment, improving outcomes in complex MI cases.
Background:
Although balloon angioplasty and stenting are effective in the treatment of acute myocardial infarction (MI), reduced coronary flow and distal embolization frequently complicate interventions when thrombus is present. Adjunctive treatment with mechanical thrombectomy devices may reduce these complications.
Methods And Results:
We evaluated the angiographic and clinical outcomes of 70 patients with acute MI (16% with cardiogenic shock) and with angiographically evident thrombus who were treated with AngioJet rheolytic thrombectomy followed by immediate definitive treatment. Procedure success (residual diameter stenosis <50% and Thrombolysis in Myocardial Infarction [TIMI] flow > or =2 after final treatment) was achieved in 93.8%. Clinical success (procedure success without major in-hospital cardiac events) was achieved in 87.5%, with an in-hospital mortality rate of 7.1%. Final TIMI 3 flow was achieved in 87.7%. AngioJet treatment resulted in a mean thrombus area reduction from 73.2 +/- 64.6 mm(2) at baseline to 15.5 +/- 30.1 post-thrombectomy (P <.001). Subsequent definitive treatment included stenting in 67% and balloon angioplasty alone in 26% of patients. Procedural complications included distal embolization in six patients and perforation in two patients. There were no further major adverse events during 30-day follow-up.
Conclusion:
Rheolytic thrombectomy can be performed safely and effectively in patients with acute MI, allowing for immediate definitive treatment in thrombus-containing lesions.
