A new approach of primary angioplasty for ST-elevation acute myocardial infarction based on minimalist immediate mechanical intervention

Isaaz, Karl; Robin, Christophe; Cerisier, Alexis; Lamaud, M; Richard, L.; Costa, Antoine Da; Sabry, Mohamed Hassan; Gerenton, Claude; Blanc, Jean Louis

doi:10.1097/00019501-200605000-00010

Cited by 56 publications

(38 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, several groups are reexamining this approach, and new treatment strategies are now emerging. Isaaz's 32 months. In the series as a whole, there were no acute events (ACS or sudden death).…”

Section: Discussionmentioning

confidence: 99%

Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions

Amabile¹,

Combaret²,

Hammas³

et al. 2015

EuroIntervention

View full text Add to dashboard Cite

2 STRUCTURED ABSTRACT Aims:To assess whether a strategy of invasive management without stents in selected acute coronary syndrome (ACS) patients with a large thrombus burden (LTB) might be feasible and safe. Methods and results:We performed a prospective non-randomised observational cohort study of invasive treatment decisions guided by optical coherence tomography (OCT) in selected ACS patients with LTB.Among 852 ACS patients who had undergone invasive coronary angiography, 101(11.8%) patients with large thrombus burden on initial angiography underwent thrombectomy to restore TIMI-3 flow without stenting. All of these patients then had repeat angiography with OCT (Day 0-2 (Group1), Day 3-6 (Group2) or Day 7-30 (Group3)).No adverse events occurred between the initial and second angiograms. Residual thrombus was detected in 68% of patients with OCT (respectively, 94%, 79% and 32% in Group1, Group2 and Group3) and 20% of cases with angiography. Plaque rupture was detected by OCT in 65% of cases. Minimal lumen area was 2.81mm 2 , 3.40mm 2 and 4.89mm 2 in Group1, Group2 and Group3, respectively. 62% of patients were stented (respectively, 76%, 61% and 50%). During a minimum follow-up period of 12 months in all patients, 1 non-fatal MI occurred and 1 PCI was performed for angina. Conclusions:Medical management without stents is safe and feasible in selected ACS patients with LTB.OCT revealed culprit lesion characteristics that were not disclosed by angiography and facilitated treatment decisions. 3 KEY WORDSAcute coronary syndrome, optical coherence tomography, coronary thrombosis, myocardial infarction, percutaneous coronary intervention. 4 CONDENSED ABSTRACTWe assessed the feasibility and safety of invasive management and selected stenting or not, as guided by angiography and OCT, in ACS patients with LTB. In a 2-stage strategy, angiography was used to select patients for delayed stenting, and in the second procedure angiography and OCT were used to decide on stenting or not. OCT improved the assessment of culprit lesion characteristics and thrombus burden. Of 101 STEMI patients, 38% did not receive a stent. There were no adverse events related to OCT and only 2 non-fatal MACEs occurred during 12 months of follow-up. 5 ABBREVIATIONS LIST

show abstract

Section: Discussionmentioning

confidence: 99%

Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions

Amabile¹,

Combaret²,

Hammas³

et al. 2015

EuroIntervention

View full text Add to dashboard Cite

show abstract

“…In our study, we found that patients with a target lesion length >13.5 mm were 5.4-fold more likely to develop the no-reflow phenomenon than those with a target lesion length ≤13.5 mm. As suggested by Isaaz et al, 32 we advise treatment with low-dose thrombolytic drugs or glycoprotein receptor antagonists and postponing of PCI if adequate antegrade flow is achieved by initial predilatation in patients with high thrombus burden or a long target lesion.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Procedural Predictors of No-Reflow Phenomenon After Primary Percutaneous Coronary Interventions Experience at a Single Center

Kırma

Izgi

Dündar

et al. 2008

Circ J

View full text Add to dashboard Cite

he aim of treatment for acute myocardial infarction (AMI) is to restore full antegrade blood flow in the infarct-related artery (IRA) and minimize ischemic damage to the myocardium. Thrombolytic therapy is an option, but primary percutaneous coronary intervention (PCI) is the treatment of choice, based on lower rates of recurrent ischemia or infarction and good success rates in restoring antegrade blood flow in the IRA. 1,2 However, primary PCI is associated with a serious problem known as the no-reflow phenomenon (Thrombolysis In Myocardial Infarction (TIMI) flow ≤2), which occurs in 5-25% of cases. 3,4 Although PCI achieves full patency of epicardial arteries, patients who develop this phenomenon are at increased risk for left ventricular dysfunction, more progressive myocardial damage, and have higher rates of morbidity and mortality. 5,6 A number of studies have focused on the risk factors, but most of those investigators used nuclear imaging techniques, 7 myocardial contrast echocardiography, 8 Doppler flow measurements, 9 TIMI frame count method 10 or myocardial blush grade 11 to assess no-reflow phenomenon.Although these techniques have greater accuracy for detecting post-PCI suboptimal reperfusion, TIMI flow grade is the easiest and most commonly used method of evaluating primary PCI success. 12 The aim of this study was to identify simple clinical factors, angiographic findings and procedural features that predict no-reflow phenomenon in patients with AMI who undergo primary PCI. Methods Study PopulationThis prospective observational study was conducted in the Cardiology Department of Kartal Kosuyolu Yuksek Ihtisas Education and Research Hospital between January 2003 and February 2006. During this period, emergency cardiac catheterization was performed in 612 patients who (1) presented with AMI of ≤12 h duration or (2) were admitted between 12 and 24 h after onset with signs and symptoms of continuing ischemia. Exclusions were: patients treated conservatively for coronary artery spasm or ≤50% diameter stenosis of the culprit lesion with normal coronary blood flow; patients who required emergency surgical revascularization for severe left main coronary artery or Circ J 2008; 72: 716 -721 (Received May 15, 2007; revised manuscript received December 7, 2007; accepted December 25, 2007) Background The aim of the study was to identify clinical factors, angiographic findings, and procedural features that predict no-reflow phenomenon (Thrombolysis In Myocardial Infarction (TIMI) flow grade ≤2) in patients with acute myocardial infarction (AMI) who undergo primary percutaneous coronary intervention (PCI). Methods and Results A series of 382 consecutive patients with AMI underwent primary PCI within 12 h of symptom onset. Patients with ischemic symptoms continuing for more than 12 h were also included. Clinical, angiographic and procedural data were collected for each subject. Ninety-three (24.3%) of the patients developed no-reflow phenomenon, and their findings were compared with those of the reflow grou...

show abstract

“…A recent study by Isaaz et al 27) confirmed that this approach results in immediate and sustained recanalization, with a high rate of ST-segment resolution in about 80% of patients with STEMI, a percentage close to that observed after stent implantation.…”

mentioning

confidence: 75%

Glucose-6-Phosphate Dehydrogenase (G6PDH) Deficiency in a Patient with ST-Segment Elevation Acute Myocardial Infarction Successfully Treated by Simple Thrombectomy

Porto

Leo

Crea

2011

JAT

View full text Add to dashboard Cite

We report the case of an 82-year-old Sardinian woman affected by "favism" (i.e. intolerance to fava beans) with chest pain associated with persistent massive ST elevation in V2-V6 leads, admitted to our department after transfer from a rural hospital without catheterization facilities. On immediate transfer to the catheterization laboratory for primary percutaneous intervention (PCI), coronary angiogram showed proximal left anterior descending (LAD) thrombotic occlusion. In consideration of her history of glucose-6 phosphate dehydrogenase deficiency and "loss of consciousness" at a young age after taking aspirin, which contraindicated aspirin therapy, we treated this patient using a new, two-step strategy, with an emergency minimalist intervention using manual thrombectomy and intracoronary glycoprotein b/ a (GP b a) inhibition with abciximab. Subsequent angiography control confirmed the persistence of Thrombolysis in Myocardial Infarction Trial (TIMI) grade 3 flow and the presence of an intermediate proximal LAD coronary lesion, which was not treated, also due to the persisting contraindication to aspirin. In our opinion, minimalist intervention with a thrombectomy device (especially in patients characterized by a high intracoronary thrombus burden) and/or with the use of a small balloon or gentle dilation, sustained by maximized antithrombotic therapy may represent an interesting and rational approach, allowing interventionalists to postpone stenting in the setting of primary PCI in special cases. J Atheroscler Thromb, 2011; 18:425-430.Key words; Favism, Myocardial infarction, Manual thrombectomy cessfully treated this patient using a two-step strategy, with an emergency minimalist intervention using manual thrombectomy and intracoronary glycoprotein b/ a (GP b a) inhibition with abciximab. This case shows that an aggressive, thrombectomyonly strategy may be sufficient to restore flow in an emergency, and recanalization may be sustained by a maximized antithrombotic regimen (abcximab, clopidogrel and heparin) allowing interventionalists to postpone stenting in the setting of primary PCI in special cases. Case PresentationA 82-year-old hypercholesterolemic Sardinian woman with chest pain of one-hour duration, associated with persistent massive ST elevation in V2-V6 leads, was admitted to our department after transfer

show abstract

A new approach of primary angioplasty for ST-elevation acute myocardial infarction based on minimalist immediate mechanical intervention

Cited by 56 publications

References 36 publications

Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions

Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions

Clinical and Procedural Predictors of No-Reflow Phenomenon After Primary Percutaneous Coronary Interventions Experience at a Single Center

Glucose-6-Phosphate Dehydrogenase (G6PDH) Deficiency in a Patient with ST-Segment Elevation Acute Myocardial Infarction Successfully Treated by Simple Thrombectomy

Contact Info

Product

Resources

About