Sustained Mechanical Aspiration Thrombectomy for High Thrombus Burden Coronary Vessel Occlusion: The Multicenter CHEETAH Study

Abstract

Background: Poor myocardial reperfusion due to distal embolization and microvascular obstruction after percutaneous coronary intervention is associated with increased risk of morbidity and mortality. Prior trials have not shown a clear benefit of routine manual aspiration thrombectomy. Sustained mechanical aspiration may mitigate this risk and improve outcomes. The objective of this study is to evaluate sustained mechanical aspiration thrombectomy before percutaneous coronary intervention in high thrombus burden acute coronary syndrome patients. Methods: This prospective study evaluated the Indigo CAT RX Aspiration System (Penumbra Inc, Alameda CA) for sustained mechanical aspiration thrombectomy before percutaneous coronary intervention at 25 hospitals across the USA. Adults presenting within 12 hours of symptom onset with high thrombus burden and target lesion(s) located in a native coronary artery were eligible. The primary end point was a composite of cardiovascular death, recurrent myocardial infarction, cardiogenic shock, or new or worsening New York Heart Association class IV heart failure within 30 days. Secondary end points included Thrombolysis in Myocardial Infarction thrombus grade, Thrombolysis in Myocardial Infarction flow, myocardial blush grade, stroke, and device-related serious adverse events. Results: From August 2019 through December 2020, a total of 400 patients were enrolled (mean age 60.4 years, 76.25% male). The primary composite end point rate was 3.60% (14/389 [95% CI, 2.0–6.0%]). Rate of stroke within 30 days was 0.77%. Final rates of Thrombolysis in Myocardial Infarction thrombus grade 0, Thrombolysis in Myocardial Infarction flow 3, and myocardial blush grade 3 were 99.50%, 97.50%, and 99.75%, respectively. No device-related serious adverse events occurred. Conclusions: Sustained mechanical aspiration before percutaneous coronary intervention in high thrombus burden acute coronary syndrome patients was safe and was associated with high rates of thrombus removal, flow restoration, and normal myocardial perfusion on final angiography.

Use of the Indigo CAT RX aspiration system during percutaneous coronary intervention

“…TIMI 3 flow was more often achieved in the CHEETAH study compared with the present study, which could be attributed to inclusion of patients with late presentation (>12 h) in our study. 7 In our study technical success was lower in lesions that T A B L E 5 Summary of studies that investigated the outcomes with use of the Indigo CAT RX system. were previously treated with manual thrombectomy.…”

“…[3][4][5][6] The Indigo CAT RX Aspiration System (Penumbra Inc.) was designed to improve thrombectomy techniques by applying consistent vacuum. 7 Table 1 compares the Indigo CAT RX system and manual aspiration thrombectomy catheters. We examined the clinical and angiographic characteristics, as well as procedural techniques and outcomes of patients who underwent treatment with the Indigo CAT RX system at a large tertiary care hospital.…”

Aspiration thrombectomy: safe removal of thrombi too big to aspirate

“…This can be done safely in the left main or right coronary arteries as long as the guide catheter is coaxial. Devices that provide continuous powered aspiration may alleviate concerns of a thrombus dislodging inside the guide catheter and placed at risk of dislodging into the systemic circulation 8. Alternatively, a strategy of aspirating the thrombus deep inside the artery using a mother-and-child catheter allows entrainment of the thrombus and should help prevent dislodgement and embolisation 9…”

Clot Management in Primary Percutaneous Coronary Intervention: Fighting Your Enemy

“…TIMI 3 flow was achieved in 90.2%, compared to 87% of TIMI 0 or 1 flow at baseline. 29 The CHEETAH study is a single-arm, prospective multicentre study of 400 patients with TIMI thrombus grade 4 or 5. Preliminary data showed that TIMI thrombus grade was 92.4% at grade 4-5 at baseline; this was improved to 72.8% at lower than grade 4 after thrombectomy, and 99.5% at grade 0 at the end of the procedure.…”

“…30 In both series, no device-related serious adverse events were reported. 29,30 Another novel approach is mechanical thrombectomy using the Solitaire device (Medtronic), which has been shown to be safe and effective in the treatment of acute ischaemic stroke. Initial experience in a small cohort of patients showed that the device was applicable to intracoronary thrombus and was highly efficacious in reducing thrombus burden and improving TIMI flow in patients with high thrombus burden despite other conventional therapies.…”