Interventional CardiologyRheolytic thrombectomy during percutaneous revascularization for acute myocardial infarction: Experience with the AngioJet catheter☆
Section snippets
Patient population
The study population included 70 consecutive patients who had a transmural acute MI within 8 hours of symptom onset and who were enrolled in the Food and Drug Administration (FDA)–approved Vein Graft AngioJet Study-1 (VeGAS 1) or VeGAS 2 acute MI Registry. The protocols were approved by the Institutional Review Boards at each site. Sixteen patients were drawn from VeGAS 1, a 90-patient pilot registry of AngioJet thrombectomy in thrombus-containing saphenous vein bypass grafts and native
Baseline characteristics
Baseline demographic and clinical characteristics are summarized in Table I.Characteristic N = 70 patients, 70 lesions Age (mean ± SD) 60 ± 11 years No. of men 66% Hypertension 48% Dyslipidemia 24% Tobacco use 42% Diabetes mellitus 19% Prior MI 37% Prior coronary artery bypass graft 22% LV ejection fraction (mean ± SD) 44% ± 10% Duration of chest pain (mean ± SD) 3.7 ± 1.9 hours Extent of coronary disease 1 vessel 56% 2 vessel 26% 3 vessel 19% Cardiogenic shock 16% Peak
Discussion
The current study showed that AngioJet treatment successfully removed angiographically evident intracoronary/graft thrombus (net thrombus area reduction of 57.7 mm2), resulting in final TIMI 3 flow in the majority of patients (87.8%). Our series of 70 patients represents a severely ill, high-risk subset of patients with acute MI: 16% had cardiogenic shock, the mean baseline ejection fraction was 44%, 37% had prior MI, and the culprit thrombus lesion was located in a saphenous vein graft or the
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Cited by (104)
American College of Cardiology Annual Scientific Session 2010: Update in interventional cardiology
2010, JACC: Cardiovascular InterventionsCitation Excerpt :The JETSTENT (Comparison of AngioJet Rheolytic Thrombectomy before Direct Infarct Artery Stenting to Direct Stenting Alone in Patients with Acute Myocardial Infarction) trial (6) evaluated the use of rheolytic thrombectomy before direct stenting of the infarct-related artery in patients with acute MI. In contrast to the TAPAS (Thrombus Aspiration during Percutaneous Coronary Intervention in Acute Myocardial Infarction Study) (7), which showed improved reperfusion and clinical outcomes with the use of a mechanical aspiration catheter, the AiMI (AngioJet Rheolytic Thrombectomy in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction) study (8) previously showed that rheolytic thrombectomy with AngioJet (Medrad Interventional/Possis, Minneapolis, Minnesota) did not significantly reduce infarct size. The JETSTENT study, however, only included patients with angiographically visible thrombus, and thrombectomy was performed with a single-pass antegrade approach moving in a proximal-to-distal direction in an attempt to prevent embolization, and this was associated with better reperfusion defined by significantly greater achievement of 50% ST-segment resolution at 30 min and trends toward lower major adverse cardiac events at 30 days and 6 months.
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Reprint requests: Richard E. Kuntz, MD, MSc, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02215. E-mail: [email protected]