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Effectiveness of rheolytic coronary thrombectomy with the AngioJet catheter
Stéphane Rinfret1, Peter T Katsiyiannis, Kalon K L Ho
1Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
Insights
Rheolytic thrombectomy effectively removed thrombus in coronary arteries and saphenous vein grafts, improving blood flow and leading to favorable patient outcomes. This intervention demonstrated significant success in reducing thrombus burden and restoring TIMI-3 flow.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Surgery
Background:
- Thrombus-laden lesions increase risks of acute complications and restenosis after coronary interventions.
- Evaluating novel thrombectomy devices is crucial in the era of glycoprotein IIb/IIIa blockade.
Purpose of the Study:
- To assess the clinical effectiveness of rheolytic thrombectomy using the AngioJet device.
- To evaluate outcomes in a non-selected patient population receiving glycoprotein IIb/IIIa blockade.
Main Methods:
- Retrospective review of 119 patients undergoing 126 AngioJet procedures (coronary arteries and saphenous vein grafts).
- Data analysis included clinical, angiographic, and procedural outcomes.
- Glycoprotein IIb/IIIa blockers were utilized in 88% of cases.
Main Results:
- Significant thrombus removal (76% in SVGs, 66% in native arteries) and improved Thrombolysis In Myocardial Infarction (TIMI) flow.
- High rates of angiographic success (73% in SVGs, 87% in native arteries).
- Distal embolization occurred in 13% of cases, less with abciximab.
Conclusions:
- Rheolytic thrombectomy is effective in reducing thrombus burden and restoring TIMI-3 flow.
- The procedure is associated with favorable short- and long-term clinical outcomes.
- Favorable AngioJet response and freedom from embolization correlate with procedural success.
Abstract:
Thrombus-filled lesions are associated with a higher rate of acute complications and long-term restenosis following conventional coronary or saphenous vein graft (SVG) intervention. To evaluate the clinical effectiveness of rheolytic thrombectomy in a nonselected population in the glycoprotein IIb/IIIa blockade era, we reviewed clinical, angiographic, and procedural data on 119 patients who underwent 126 consecutive coronary AngioJet procedures (29% in SVGs, and 71% in native coronary arteries) from July 1998 to August 2000. Glycoprotein IIb/IIIa blockers were used in 88%. Most vessels (68% of SVGs, 74% of native coronary arteries) were occluded initially. Complete or substantial removal of filling defects was achieved in 76% of SVGs and 66% of native coronary cases. The AngioJet rheolytic thrombectomy device led to significant improvement in lumen diameter and Thrombolysis In Myocardial Infarction (TIMI) flow, with reduction in the thrombotic lesion length (p <0.05). Angiographic success (<30% residual stenosis, TIMI-3) was attained in 73% of SVGs and 87% of native coronary procedures. Distal embolization occurred in 13 cases, and was less likely to occur in patients treated with abciximab (0%) compared with patients treated with other glycoprotein IIb/IIIa blockers or heparin alone (17%, p = 0.02). A favorable response to the AngioJet (odds ratio 3.9) and freedom from embolization (odds ratio 14.6) were associated with a higher procedural success rate. In-hospital and long-term clinical outcomes were favorable. Thus, rheolytic thrombectomy resulted in significant reduction of the thrombus burden in most patients, restored TIMI-3 flow, and led to favorable short- and long-term outcomes.