title: Intracoronary thrombectomy with the X-sizer catheter system improves epicardial flow and accelerates ST-segment resolution in patients with acute coronary syndrome: a prospective, randomized, controlled study.
abstract: BACKGROUND
  In patients with acute coronary syndrome (ACS), percutaneous coronary intervention (PCI) may cause thrombus dislodgment followed by reduced flow and impaired microcirculatory function. We prospectively compared conventional PCI to a strategy of additional pretreatment using the X-sizer thrombectomy system.
  
  
  RESULTS
  Sixty-six patients (51 [77%] men; 54.9+/-9.9 years) with ACS (49 with ST-elevation infarction [STEMI]) and suspected intracoronary thrombus were randomized 1:1 to pretreatment with X-sizer and conventional PCI alone. Various aspects of epicardial flow and microvascular function were studied. Baseline data were similar in both groups. Postprocedural TIMI 3 flow was obtained in 90% of X-sizer-treated patients and in 84% of controls (NS); however, corrected TIMI frame count was lower in X-sizer- treated patients (18.3+/-10.2 versus 24.7+/-14.1; P<0.05). No significant group differences were observed in final coronary flow reserve, myocardial blush grade, and myocardial dye intensity. In STEMI, the sum of ST elevation was significantly lower in X-sizer-treated patients immediately after (2.78+/-3.05 versus 6.15+/-6.32 mm; P<0.03) and 6 hours after (2.17+/-2.31 versus 4.14+/-3.7 mm; P<0.05) intervention. ST-segment resolution >50% was observed in 83% of X-sizer-treated patients and in 52% of controls (P<0.03). Multivariate analysis identified X-sizer treatment as the single independent predictor of ST-segment resolution >50% (OR 4.35; 95% CI, 1.13 to 16.9; P<0.04). Major adverse cardiac events after 30 days occurred in 2 patients in each group.
  
  
  CONCLUSIONS
  In ACS with suspected thrombus, pretreatment with the X-sizer catheter system improves epicardial flow and accelerates ST-segment resolution compared with conventional PCI alone.
authors.affiliation: Department of Cardiology and Emergency Medicine University of Vienna, Vienna, Austria.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Beran
authors.forename: Irene
authors.initials: I
authors.lastname: Lang
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schreiber
authors.forename: Stefan
authors.initials: S
authors.lastname: Denk
authors.forename: Thomas
authors.initials: T
authors.lastname: Stefenelli
authors.forename: Bonni
authors.initials: B
authors.lastname: Syeda
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.forename: Dietmar
authors.initials: D
authors.lastname: Glogar
authors.forename: Peter
authors.initials: P
authors.lastname: Siostrzonek
mesh_terms: D000208:Acute Disease; D015906:Angioplasty, Balloon, Coronary; D001783:Blood Flow Velocity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000601:surgery*; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000503:physiopathology* / Q000601:surgery*; D004562:Electrocardiography; D004617:Embolism / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000503:physiopathology; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D012212:Rheology; D017131:Thrombectomy / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome