The emergence of mechanical thrombectomy; a clot burden reduction approach.
Intracoronary thrombi are harbingers for increased procedural complications after percutaneous revascularization techniques. Current approaches to treat coronary thrombus prior to plaque intervention are pharmacologic and mechanical. Whereas the use of coronary thrombolysis prior to or during percutaneous coronary intervention have yielded mixed results, the group of the platelet IIb/IIIa inhibitors have uniformly been shown to decrease the procedural complications and the 30 day rate of major cardiovascular events. Mechanical approaches to managing thrombus include: compression with balloon angioplasty or stenting, removal with atherectomy devices, thromboaspiration with the Possis AngioJet and hydrolyser, and vibration disintegration with the ultrasound thrombolysis device. Recent clinical trials have shown that the Possis AngioJet and the ultrasound thrombolysis device are highly effective and safe for removing coronary thrombi prior to coronary intervention.
Silva
J A
JA
Department of Cardiology, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana 70121, USA.
Ramee
S R
SR
D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization / Q000295:instrumentation; D003328:Coronary Thrombosis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D016032:Randomized Controlled Trials as Topic; D015607:Stents; D015912:Thrombolytic Therapy; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014568:Urokinase-Type Plasminogen Activator