Efficacy of Rheolytic Thrombectomy in Early Versus Late Myocardial Infarction

Abstract

Rheolytic thrombectomy with the AngioJet catheter is more effective in terms of improvement in coronary blood flow as assessed by TFCs when used less than 12 hours after the onset of clinical symptoms suggestive of AMI.

Rheolytic Thrombectomy during Percutaneous Coronary Intervention Improves Long‐Term Outcome in High‐Risk Patients with Acute Myocardial Infarction

“…Moreover, Antoniucci et al 13 showed a lower cTFC in the thrombectomy group with smaller infarct size and no MACE at 1 month. Makaryus et al also described procedural success of 75% with AngioJet ® thrombus aspiration in 61 patients presented with AMI 15 . On the other side, a recent large randomized AMI trial on routine use of a protection device during rheolytic thrombectomy with AngioJet ® , 21,22 as with other large trials on routine use of distal protection devices, 23,24 failed to demonstrate any positive effect on myocardial reperfusion or clinical outcome.…”

“…Previous reports have already described favorable outcomes with the use of aspiration thrombectomy, both in angiographic and clinical terms. In preliminary reports of the European AngioJet Rapid Thrombectomy Study (Euro‐ARTS), device success was obtained in 80% of patients, in the absence of death, reinfarction, and need of revascularization during thehospital stay 15,19,20 . In the Vein Graft AngioJet Study I(VeGAS I), TIMI 3 flow was reached in 88% of patients, with encouraging clinical outcome at 30 days 11 .…”

“…Another important question about the efficacy of aspiration thrombectomy in AMI is the timing of the intervention. Makaryus et al have already discussed the matter in a recent paper 15 . In particular, they concluded that the AngioJet ® system is more beneficial with acute thrombotic lesions, which show active inflammation and are the main cause of acute coronary syndromes.…”

“…The presence of high thrombotic burden was defined according to the TIMI IIIA investigator's angiographic assessment guidelines 14 . A sentinel right ventricle pacing lead was placed in patients who underwent PCI of native right coronary or dominant circumflex coronary artery or venous graft treatment to prevent potential AngioJet ® ‐induced bradyarrhythmias during the aspiration procedure 15,16 . The rheolytic thrombectomy system, consisting of a drive unit control console, a pump set, and a disposable single‐use thrombectomy catheter was then assembled.…”