Interventional Cardiology
Rheolytic thrombectomy during percutaneous revascularization for acute myocardial infarction: Experience with the AngioJet catheter

https://doi.org/10.1067/mhj.2001.112997Get rights and content

Abstract

Background Although balloon angioplasty and stenting are effective in the treatment of acute myocardial infarction (MI), reduced coronary flow and distal embolization frequently complicate interventions when thrombus is present. Adjunctive treatment with mechanical thrombectomy devices may reduce these complications. Methods and Results We evaluated the angiographic and clinical outcomes of 70 patients with acute MI (16% with cardiogenic shock) and with angiographically evident thrombus who were treated with AngioJet rheolytic thrombectomy followed by immediate definitive treatment. Procedure success (residual diameter stenosis <50% and Thrombolysis in Myocardial Infarction [TIMI] flow ≥2 after final treatment) was achieved in 93.8%. Clinical success (procedure success without major in-hospital cardiac events) was achieved in 87.5%, with an in-hospital mortality rate of 7.1%. Final TIMI 3 flow was achieved in 87.7%. AngioJet treatment resulted in a mean thrombus area reduction from 73.2 ± 64.6 mm2 at baseline to 15.5 ± 30.1 post-thrombectomy (P <.001). Subsequent definitive treatment included stenting in 67% and balloon angioplasty alone in 26% of patients. Procedural complications included distal embolization in six patients and perforation in two patients. There were no further major adverse events during 30-day follow-up. Conclusion Rheolytic thrombectomy can be performed safely and effectively in patients with acute MI, allowing for immediate definitive treatment in thrombus-containing lesions. (Am Heart J 2001;141:353-9.)

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.

. Baseline demographic and clinical characteristics

CharacteristicN = 70 patients, 70 lesions
Age (mean ± SD)60 ± 11 years
No. of men66%
Hypertension48%
Dyslipidemia24%
Tobacco use42%
Diabetes mellitus19%
Prior MI37%
Prior coronary artery bypass graft22%
LV ejection fraction (mean ± SD)44% ± 10%
Duration of chest pain (mean ± SD)3.7 ± 1.9 hours
Extent of coronary disease
 1 vessel56%
 2 vessel26%
 3 vessel19%
Cardiogenic shock16%
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

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      Citation 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]

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