Coronary Artery Disease
Thrombectomy with AngioJet catheter in native coronary arteries for patients with acute or recent myocardial infarction

https://doi.org/10.1016/S0002-9149(99)00003-XGet rights and content

Abstract

The AngioJet thrombectomy catheter removes thrombi by rheolytic fragmentation and suction. The purpose of this study was to identify the efficacy and safety of this new device. Myocardial infarction (MI) is associated with intracoronary thrombus. Intracoronary thrombus has been identified as a risk factor of unfavorable outcome after percutaneous transluminal coronary angioplasty. To what extent the AngioJet is applicable or effective for acute or recent MI in native coronary artery is not clear. Thrombectomy with the AngioJet was attempted in 31 patients with 31 native coronary arteries selected from 304 patients with acute or recent MI. Follow-up angiography was performed at 3 to 6 months. Procedure success was achieved in 29 patients (94%). Adjunctive balloon angioplasty was performed after AngioJet thrombectomy in 30 patients (97%), and in only 1 patient (3%) AngioJet thrombectomy was the sole procedure. Subsequent stenting after balloon angioplasty was attempted successfully in 12 patients (40%) without thrombotic complications. Thrombolysis In Myocardial Infarction trial flow grading increased from 0.70 ± 0.97 before to 2.61 ± 0.88 after AngioJet thrombectomy (p <0.0001), to 2.84 ± 0.64 after adjunctive procedures (p = 0.070). At follow-up angiography restenosis rate was 21% but Thrombolysis In Myocardial Infarction flow 3 was present in all patients. The restenosis rate of stented patients was 8%. There were no major events during in-hospital and follow-up. The AngioJet can be used safely and successfully to remove thrombus from the native coronary artery of patients with MI. Thrombus removal makes subsequent stenting safe and uncomplicated. The restenosis rate was considered to be acceptable.

Section snippets

Patient population

The study protocol was approved by the institutional review board of Kokura Memorial Hospital. Possible risks and benefits of this device were fully explained to each patient and written consent was obtained. Between November 1996 and November 1997, AngioJet thrombectomy was performed in 31 patients with 31 native coronary artery lesions. All lesions were de novo and no patient had undergone previous percutaneous intervention or coronary artery bypass surgery. Indications for using AngioJet

Patient and lesion characteristics

The baseline characteristics of patients and lesions are listed in Table I. In the 28 patients with acute MI, the time interval from onset of symptoms to emergent catheterization was <12 hours in 18 patients, within 24 hours in 2 patients, within 48 hours in 3 patients, and within 7 days in 5 patients.

Procedure success

Of the 31 patients receiving AngioJet, the procedure was planned in 28 (90%), and in 3 it was used to bail out no-reflow after balloon angioplasty. Procedural success was achieved in all 28

Relative benefits of AngioJet thrombectomy

The thrombotic pathogenesis of MI has been widely accepted,1 and therefore thrombolytic therapy with lytic agents is a logical approach. Thrombolysis with tissue plasminogen activator has been reported to be unsuccessful in recanalizing the occluded vessel in about 20% of patients.19 This has resulted in increasing interest in angioplasty, which has been reported to be superior to thrombolysis in a randomized trial,20 but the presence of thrombus was identified as a predictor of unfavorable

Acknowledgements

We would like to thank the cardiac catheterization laboratory staff for their excellent patient care. We are also indebted to Alfonso-T Miyamoto, MD, for his help with the manuscript.

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