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[Efficacy of the thrombectomy on no-reflow in patients with acute myocardial infarction]
Wei Pan1, Lan-feng Wang, Shu-sen Yang
1Department of Cardiology, The First Clinical College, Harbin Medical University, Harbin 150001, Heilongjiang, China.
Insights
Percutaneous thrombectomy significantly reduces microvascular obstruction in acute myocardial infarction (AMI) patients. This therapy improves outcomes by addressing the no-reflow phenomenon at the microvascular level.
Area of Science:
- Cardiology
- Interventional Cardiology
- Microvascular Medicine
Context:
- Acute myocardial infarction (AMI) is often associated with coronary thrombus formation.
- The no-reflow phenomenon, indicative of microvascular dysfunction, is a significant complication following percutaneous coronary intervention (PCI).
- Assessing microvascular obstruction is crucial for evaluating treatment efficacy in AMI.
Purpose:
- To investigate the efficacy of percutaneous thrombectomy in mitigating the no-reflow phenomenon in patients with AMI.
- To compare the impact of standard PCI versus PCI combined with percutaneous thrombectomy on microvascular function.
- To evaluate changes in microvascular obstruction parameters at 24 hours and 1 week post-intervention.
Summary:
- A study involving 68 AMI patients with coronary thrombus compared PCI alone (n=34) with PCI plus percutaneous thrombectomy (n=34).
- Microvascular obstruction was assessed using Contrast Score Index (CSI), regional Wall Motion Score Index (WMSI), contrast defect length (CDL), and wall motion abnormality (WML).
- Patients undergoing thrombectomy showed significantly lower CSI, WMSI, CDL/LV, and WML/LV at both 24 hours and 1 week post-PCI compared to the PCI-only group.
Impact:
- Percutaneous thrombectomy demonstrates a beneficial effect at the microvascular level in AMI patients.
- The procedure effectively reduces the no-flow phenomenon and the extent of microvascular obstruction.
- Thrombectomy is a feasible and effective therapeutic option for managing AMI, improving microvascular reperfusion.
Objective:
To study the efficacy of the percutaneous thrombectomy on no-reflow in the patients with acute myocardial infarction (AMI) with angiographically proven thrombus.
Methods:
A total of 68 patients suffering from AMI with coronary thrombus shown by angiography were randomly divided into a group of percutaneous coronary intervention (PCI) therapy (n = 34) and a group of PCI plus percutaneous thrombectomy (n = 34). At 24 hours and 1 week after PCI, real-time imaging was performed by contrast pulse sequencing technology. Contrast score index (CSI), regional wall motion score index (WMSI), endocardial length of contrast defect (CDL) and wall motion abnormality (WML) were calculated.
Results:
In patients treated with a percutaneous thrombectomy, CSI, WMSI, CDL/left ventricular length (LV), and WML/LV were significantly lower than in PCI group at both time points of observation, and these indexes were markedly decreased at 1 week after PCI compared with 24 hours after PCI (P<0.05 or P<0.01).
Conclusion:
The beneficial effect of the thrombectomy occurs at the microvascular level. Thrombectomy reduces the no-flow phenomenon and the extent of microvascular obstruction, thus it is a feasible therapy in patients with AMI.
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