Intracoronary thrombectomy with the X-sizer catheter system improves epicardial flow and accelerates ST-segment
Gilbert Beran1, Irene Lang, Wolfgang Schreiber
1Department of Cardiology and Emergency Medicine University of Vienna, Vienna, Austria.
Insights
Pretreating acute coronary syndrome (ACS) patients with the X-sizer thrombectomy system improved epicardial flow and accelerated ST-segment resolution compared to conventional percutaneous coronary intervention (PCI). This strategy shows promise for managing ACS with thrombus.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) can lead to thrombus dislodgement, reduced flow, and impaired microcirculation.
- A prospective study compared conventional PCI with a strategy involving X-sizer thrombectomy pretreatment.
Purpose of the Study:
- To evaluate the efficacy of X-sizer thrombectomy pretreatment in patients with ACS and suspected intracoronary thrombus.
- To compare epicardial flow and microcirculatory function between X-sizer pretreatment and conventional PCI alone.
Main Methods:
- Sixty-six ACS patients (49 with ST-elevation myocardial infarction [STEMI]) were randomized 1:1 to X-sizer pretreatment plus PCI or conventional PCI alone.
- Epicardial flow, microvascular function, and ST-segment changes were assessed post-intervention.
Main Results:
- X-sizer pretreatment resulted in a lower corrected TIMI frame count (18.3 vs. 24.7; P<0.05) and significantly reduced ST-segment elevation post-intervention in STEMI patients.
- ST-segment resolution >50% was achieved in 83% of X-sizer-treated patients versus 52% of controls (P<0.03).
- X-sizer treatment was an independent predictor of ST-segment resolution >50% (OR 4.35; P<0.04).
Conclusions:
- Pretreatment with the X-sizer catheter system in ACS patients with suspected thrombus improves epicardial flow.
- The X-sizer system accelerates ST-segment resolution compared to conventional PCI alone, suggesting improved microvascular reperfusion.
Background:
In patients with acute coronary syndrome (ACS), percutaneous coronary intervention (PCI) may cause thrombus dislodgment followed by reduced flow and impaired microcirculatory function. We prospectively compared conventional PCI to a strategy of additional pretreatment using the X-sizer thrombectomy system.
Methods And Results:
Sixty-six patients (51 [77%] men; 54.9+/-9.9 years) with ACS (49 with ST-elevation infarction [STEMI]) and suspected intracoronary thrombus were randomized 1:1 to pretreatment with X-sizer and conventional PCI alone. Various aspects of epicardial flow and microvascular function were studied. Baseline data were similar in both groups. Postprocedural TIMI 3 flow was obtained in 90% of X-sizer-treated patients and in 84% of controls (NS); however, corrected TIMI frame count was lower in X-sizer- treated patients (18.3+/-10.2 versus 24.7+/-14.1; P<0.05). No significant group differences were observed in final coronary flow reserve, myocardial blush grade, and myocardial dye intensity. In STEMI, the sum of ST elevation was significantly lower in X-sizer-treated patients immediately after (2.78+/-3.05 versus 6.15+/-6.32 mm; P<0.03) and 6 hours after (2.17+/-2.31 versus 4.14+/-3.7 mm; P<0.05) intervention. ST-segment resolution >50% was observed in 83% of X-sizer-treated patients and in 52% of controls (P<0.03). Multivariate analysis identified X-sizer treatment as the single independent predictor of ST-segment resolution >50% (OR 4.35; 95% CI, 1.13 to 16.9; P<0.04). Major adverse cardiac events after 30 days occurred in 2 patients in each group.
Conclusions:
In ACS with suspected thrombus, pretreatment with the X-sizer catheter system improves epicardial flow and accelerates ST-segment resolution compared with conventional PCI alone.
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