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Transradial application of PercuSurge GuardWire device during primary percutaneous intervention of infarct-related
Hon-Kan Yip1, Mien-Cheng Chen, Hsueh-Wen Chang
1Division of cardiology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Insights
This study shows that using the PercuSurge GuardWire device during primary percutaneous coronary intervention (p-PCI) for large infarct-related arteries (IRAs) with high-burden thrombus formation (HBTF) improves reperfusion and reduces complications. The transradial application (TRA) of this mechanical device is safe and effective for preventing no-reflow.
Area of Science:
- Interventional Cardiology
- Vascular Biology
- Thrombosis Research
Background:
- Large infarct-related arteries (IRAs) with high-burden thrombus formation (HBTF) are linked to the no-reflow phenomenon during primary percutaneous coronary intervention (p-PCI).
- Reducing thrombus burden before intervention is crucial for preventing no-reflow.
Purpose of the Study:
- To evaluate the transradial application (TRA) of the PercuSurge GuardWire device.
- To determine the device's impact on preventing no-reflow during p-PCI in patients with large IRAs and HBTF.
Main Methods:
- A prospective study (Group 1) utilized the PercuSurge GuardWire device in 42 patients undergoing p-PCI for large IRAs with HBTF via TRA.
- A retrospective control group (Group 2) included 101 patients with similar conditions treated with a transfemoral approach.
- Angiographic and clinical outcomes were compared between the two groups.
Main Results:
- Successful reperfusion (final TIMI-3 flow) was significantly higher in Group 1 (95.2%) compared to Group 2 (79.1%) (P = 0.005).
- Group 1 showed significantly lower incidences of vascular complications, post-PCI thromboembolisms, and major adverse cardiac events within 30 days.
- Thrombus burden was significantly reduced post-aspiration, with significant increases in minimal lumen diameter, TIMI flow grade, and myocardial blush (MB) grade.
Conclusions:
- The transradial application of the PercuSurge GuardWire device is safe and feasible for primary intervention in large IRAs with HBTF.
- Mechanical reduction of thrombus burden prior to intervention enhances final TIMI-3 flow, improves MB grade, and reduces thromboembolic events.
Abstract:
A large infarct-related artery (IRA), which mostly contains high-burden thrombus formation (HBTF) and lipid pool-like plaque contents, has been suggested to play a pivotal role in the no-reflow phenomenon during primary percutaneous coronary intervention (p-PCI). To reduce the thrombus burden of the IRA using the PercuSurge GuardWire device before intervention may be of crucial importance to preventing no-reflow. The purposes of this study were to test the transradial application (TRA) of this new mechanical device and to determine its impact on prevention of no-reflow during p-PCI. From May to September 2002, the PercuSurge GuardWire device was utilized in 42 consecutive patients with acute myocardial infarction and large IRA (vessel size >or= 3.5 mm with HBTF; group 1). From January to December 2000, p-PCI was performed in large IRA (vessel size >or= 3.5 mm) with HBTF using tranfemoral arterial approach in 101 consecutive patients (group 2). The angiographic and clinical outcomes of the two groups were compared in a chronologically consecutive manner. Successful reperfusion (final TIMI-3 flow) was significantly higher in group 1 than in group 2 patients (95.2% vs. 79.1%; P = 0.005). Moreover, the combined incidence of vascular complications, post-PCI thromboembolisms (defined as a distal embolism and a post-PCI residual thrombus score of >or= 3), and combined 30-day major adverse cardiac events were significantly lower in group 1 than in group 2 patients (all P values < 0.05). In group 1 patients, post-p-PCI myocardial blush (MB) of >or= 2 grades was found to be more than 88.0%. Furthermore, when compared with preintervention, thrombus scores were significantly reduced after aspiration (P = 0.0001), whereas the minimal lumen diameter (P = 0.0001), TIMI flow grade (P = 0.0001), and MB grade (P = 0.0001) had all significantly increased after aspiration using Export Aspiration Catheter. There were no significant differences in corrected TIMI frame count (P = 0.42), TIMI flow grade (P > 0.5), or MB grade (all P values > 0.5) between postaspiration and post-PCI. The TRA of the PercuSurge GuardWire device during primary intervention of large IRA with HBTF was safe and feasible and provided benefits to patients. The initial successful reduction of the thrombus burden with this mechanical device before intervention can be translated into increased final TIMI-3 flow, a combined MB of >or= 2 grades, and fewer final thromboembolic events.
