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Mechanical Aspiration Thrombectomy Using the Penumbra CAT RX System for Patients Presenting With Acute Coronary
Ian C Gilchrist1, Matthew J Fordham1, Robert Pyo1
1Stony Brook University Medical Center, Cardiovascular Division, Department of Medicine, Stony Brook, NY, USA.
Insights
Aspiration thrombectomy using the Penumbra CAT RX device effectively removes thrombus during percutaneous coronary intervention (PCI). This method demonstrated safety and efficacy in reducing infarct size without increasing stroke risk in cardiac catheterization patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- Distal embolization and microvascular obstruction can occur during percutaneous coronary intervention (PCI), even with normalized epicardial blood flow.
- Previous aspiration thrombectomy methods for reducing infarct size carried an increased risk of stroke, limiting their use to bailout strategies.
Observation:
- The Penumbra CAT RX aspiration thrombectomy catheter was evaluated in an academic cardiac catheterization lab between 2017 and 2020.
- The study included patients undergoing PCI, with a focus on those receiving the Penumbra CAT RX device.
- Data collected included pre- and post-procedure TIMI flow, 30-day cardiovascular death, and post-procedural stroke.
Findings:
- The Penumbra CAT RX was used in 34 patients, predominantly those with ST-elevation myocardial infarction (STEMI) (71%).
- Thrombus removal resulted in TIMI 3 flow in 88% of cases.
- No 30-day cardiovascular deaths or post-procedural strokes were reported.
Implications:
- Aspiration thrombectomy, particularly with the Penumbra CAT RX, offers clinical benefits in modern cardiac catheterization.
- The Penumbra CAT RX appears to be a safe and effective tool for acute thrombus removal.
- This technology may reduce infarct size and improve outcomes in select PCI patients without the stroke risks associated with older methods.
Abstract:
Patient undergoing PCI can have distal embolization and microvascular obstruction despite normalization of epicardial blood flow. Aspiration thrombectomy has been studied previously to reduce infarct size, but prior methods of aspiration thrombectomy were associated with increased risk of stroke and is currently recommended as a bailout strategy. Penumbra CAT RX has been recently approved for aspiration thrombectomy, we evaluated the catheter's use in an academic cardiac catheterization lab. Patients undergoing cardiac catherization at an academic medical center who had deployment of the Penumbra CAT RX from 2017 through 2020 were included in the case series. TIMI flow pre and post procedure were determined by individual operator. Endpoints included 30-day cardiovascular death and post-procedural stroke. The Penumbra CAT RX catheter was used in a total of 34 patients, with 71% STEMI, 23% NSTEMI, 3% UA, and 3% new onset heart failure. TIMI 3 flow was achieved in 88% of cases. There were no cases of 30-day cardiovascular death or post procedural stroke. Aspiration thrombectomy continues to have clinical benefit in modern cardiac catherization laboratories with use in select cases. The Penumbra CAT RX appears to be safe and highly effective at thrombus removal in the acute setting without increased stroke risk as seen with manual aspiration thrombectomy.
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