Mechanical manipulation of thrombus: coronary thrombectomy, intracoronary clot displacement, and transcatheter aspiration.
Recanalization of occluded arteries during acute myocardial infarction has been proven to prolong life and improve left ventricular function. Patients who could not receive thrombolytic therapy for failed thrombolysis and/or angioplasty were treated by mechanical manipulation of the thrombus. Three techniques were used: transcatheter aspiration, clot displacement, and thrombectomy. Five patients in shock had the thrombus aspirated from the left main and right coronary arteries. Eight patients had the clot pushed by the balloon from the mid-left anterior descending (LAD) to the apical LAD in order to reduce the area of ischemic myocardium, and 13 patients underwent a thrombectomy of the right coronary artery. These procedures enjoyed a high rate of success in reestablishing patency and a favorable long-term clinical and angiographic follow-up. Although the applicability and role of these interventions in acute myocardial infarction are not yet defined, we conclude that they are feasible and have an acceptable success and complication rate.
Shani
J
J
Department of Medicine, Maimonides Medical Center, Brooklyn, New York 11219.
Abittan
M
M
Gallarello
F
F
Frankel
R
R
D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D003328:Coronary Thrombosis / Q000150:complications / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000628:therapy; D013396:Suction; D017131:Thrombectomy / Q000009:adverse effects; D016896:Treatment Outcome