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Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Effectiveness of thrombectomy before stent implantation in acute myocardial infarction
Ren Kawaguchi1, Hiroshi Hoshizaki, Shigeru Oshima
1Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan. kawaguchi.r@cvc.pref.gunma.jp
Insights
Thrombectomy before stent implantation in acute myocardial infarction (AMI) patients improves microvascular function. This pretreatment minimizes myocardial damage by protecting coronary microvasculature, leading to better outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) risks distal embolization, potentially worsening infarct size.
- Effective strategies are needed to mitigate microvascular damage during PCI in AMI.
Purpose of the Study:
- To assess the efficacy of thrombectomy as a pretreatment before stent implantation in patients with AMI.
- To evaluate the impact of thrombectomy on myocardial salvage and microvascular function post-PCI.
Main Methods:
- A comparative study of 209 AMI patients undergoing emergency stent implantation (2000-2002).
- Group A (n=109) did not receive thrombectomy; Group B (n=100) received thrombectomy pretreatment.
- Follow-up included quantitative coronary angiography (QCA), left ventriculography, TIMI flow grade, creatine kinase levels, ejection fraction, and ST segment score.
Main Results:
- Thrombectomy pretreatment significantly increased the incidence of blush-3 post-angioplasty, indicating improved microvascular reperfusion.
- No significant differences were noted in restenosis or target lesion revascularization rates between groups.
Conclusions:
- Pretreatment with thrombectomy before stent implantation in AMI patients shows potential for reducing myocardial ischemic insult.
- Thrombectomy appears to protect the coronary microvasculature, contributing to improved myocardial salvage after PCI.
Abstract:
Percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) may cause distal embolization, with deterioration of distal flow and further extension of the infarct. The purpose of the present study was to evaluate the effectiveness of pretreatment by thrombectomy on myocardial salvage after stent implantation in patients with AMI. From January 2000 to July 2002, 209 consecutive patients with AMI successfully underwent emergency stent implantation. They were divided into 2 groups: those treated in the year before the introduction of the thrombectomy device (Group A; n=109), and those treated the year after introduction of the device (Group B; n=100). Follow-up quantitative coronary angiography (QCA) and left ventriculography were carried out 6 months after PCI. Microvascular circulation after revascularization was assessed by Thrombolysis in myocardial infarction (TIMI) flow grade analysis, the maximum creatine kinase concentration was recorded, and the follow-up left ventricular ejection fraction and ST segment score were assessed on the 12-lead electrocardiography just before revascularization and on return to the coronary care unit. The QCA data, rate of restenosis (% restenosis) and rate of target lesion revascularization were also compared between the 2 groups. The results demonstrated that the introduction of thrombectomy had increased the number of patients who displayed blush-3 after primary angioplasty, which suggests that thrombectomy before stent implantation has the potential to minimize myocardial ischemic insult, presumably by protecting the coronary microvasculature.
