Related Experiment Videos
[Rheolytic percutaneous thrombectomy with Angiojet (Possis) catheter in acute coronary syndromes. Report of 3 cases
Pasquale Lisanti1, Walter Serino, Rosario Fiorilli
1Divisione di Cardiologia-Emodinamica, Azienda Ospedaliera San Carlo, Potenza. pasqualelisanti@tin.it
Insights
Mechanical thrombolysis using the Angiojet system effectively treated coronary thrombosis in three acute coronary syndrome cases. This approach facilitated stenting, cleared thrombosed grafts, and improved cardiac function.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
Background:
- Mechanical thrombolysis for acute coronary syndromes is underutilized.
- Thrombotic coronary obstruction requires effective treatment strategies.
Observation:
- The Possis Angiojet system was employed in three distinct clinical scenarios.
- Case 1: Treated subocclusive thrombus in the right coronary artery.
- Case 2: Managed stent prolapse with thrombus in the left anterior descending artery.
- Case 3: Addressed extensive thrombus in a vein graft during acute myocardial infarction with cardiogenic shock.
Findings:
- Successful thrombus removal was achieved in all three cases using the Angiojet system.
- Facilitated safe and direct stenting after thrombus debulking.
- Restored TIMI 3 flow in a thrombosed graft, improving left ventricular function and hemodynamics.
Implications:
- The Angiojet system shows promise as an effective tool for mechanical thrombolysis in complex coronary interventions.
- Demonstrates potential for improving outcomes in acute coronary syndromes with significant thrombotic burden.
- Highlights the need for further evaluation of indications and results for this device.
Abstract:
Mechanical thrombolysis in acute coronary syndromes is poorly understood and is still considerably underused in interventional cardiology. The authors report 3 cases of thrombotic coronary obstruction successfully treated with the Possis Angiojet system. In the first case, coronary angiography which demonstrated a large subocclusive thrombus in the mid right coronary artery was performed in a patient with unstable angina following acute myocardial infarction. Removal of the bulk of the thrombus through the activation of the Angiojet system allowed safe and direct stenting of the residual obstruction. In the second case, the Angiojet system was used to remove a thrombus which prolapsed within a stent during a primary angioplasty procedure on the left anterior descending coronary artery. The third case demonstrates the efficacy of the Possis Angiojet system in cleaning up an extensively thrombosed vein graft of an elderly patient with acute anterior myocardial infarction and cardiogenic shock. After thrombus debulking and restoration of TIMI 3 flow in the graft and in the native left anterior descending coronary artery, the left ventricular function was restored and the hemodynamic picture improved. This technique, the indications and results of this promising new device are discussed and reviewed in detail.