Feasibility of sequential thrombus aspiration and filter distal protection in the management of very high thrombus burden lesions

Francesco Burzotta, Carlo Trani, Enrico Romagnoli, Maria De Vita, Giovanni Paolo Talarico, Giuseppe Ferrante, Italo Porto, Antonio Maria Leone, Giampaolo Niccoli, Giovanni Schiavoni, Antonio Giuseppe Rebuzzi, Rocco Mongiardo, Mario Attilio Mazzari, Filippo Crea

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: A series of thrombectomy and distal filter devices have been developed to limit distal embolization during percutaneous coronary interventions (PCI). OBJECTIVE: To evaluate the feasibility of the combined use of thrombus-aspirating catheters and distal filter devices in patients at high risk of no-reflow. METHODS: Thrombus aspiration (TA) and distal filter protection (DFP) were sequentially used in a series of patients undergoing urgent PCI within 48 hours of acute myocardial infarction (MI). Inclusion criteria were: (1) occlusion of the infarct-related artery; (2) at least 2 out of the 6 Yip's classification features of high thrombus burden. Coronary angiograms were evaluated off-line to assess thrombus score, coronary flow and distal embolization in different phases of the procedure. RESULTS: TA followed by DFP prior to balloon dilatation or stent implantation was successfully performed in 20 patients with acute MI due to occlusion of de novo lesions (80%) or in-stent thrombosis (20%) located in a native coronary artery (90%) or a saphenous vein graft (10%). TA was associated with a significant acute reduction of TS and improvement of coronary flow (TIMI grade from 0.7 ± 0.8 to 1.6 ± 1.1; p ≤ 0.004 and CTFC from 83 ± 29 to 52 ± 36; p ≤ 0.006). This facilitated the deployment of DFP, which did not induce significant flow modification (TIMI grade: 2.3 ± 0.9 pre-DFP placement vs. 2.2 ± 1.0 post-DFP placement; p ≤ 0.20; CTFC: 32 ± 28 pre-DFP placement vs. 35 ± 28 post-DFP placement; p ≤ 0.47). Post-PCI angiography revealed a 90% TIMI 3 flow rate and 47% MBG 3 rate with only 1 case of angiographically evident distal embolization. CONCLUSIONS: Sequential use of TA and DFP may be successfully used during PCI in patients at very high risk of distal embolization. However, the possible benefits of such an approach should be weighted with the increased complexity of the procedure. Further evaluations of the clinical efficacy of this approach are needed.

Original languageEnglish
Pages (from-to)317-323
Number of pages7
JournalJournal of Invasive Cardiology
Volume19
Issue number8
Publication statusPublished - Aug 2007

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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