title: Treatment of coronary stent thrombosis with rheolytic thrombectomy: results from a multicenter experience.
abstract: The objective of this study was to assess the feasibility, efficacy, and safety of rheolytic thrombectomy (RT) for treatment of coronary stent thrombosis. Stent thrombosis is an infrequent but potentially devastating complication. Conventional treatment with balloon angioplasty and/or thrombolysis has yielded suboptimal results. RT was used to treat 18 patients (mean age, 62 +/- 8 years; 72% male) with in-stent thrombosis (mean time to stent thrombosis, 2.4 +/- 1.8 days). Device success, procedure success, in-hospital and 30-day major cardiovascular events (MACE) were assessed in the hospital and at 30 days. Device success was obtained in 94% and procedure success was achieved in 100% of patients. Following RT, 11 patients underwent balloon angioplasty and 7 patients received additional stents. TIMI 3 coronary flow was obtained in 94.4% and all (100%) patients achieved either TIMI 2 or 3 coronary flow. The angiographic thrombus area decreased from 113.7 +/- 79 to 5.5 +/- 5.7 mm(2) after RT, and to 0.9 +/- 2.1 mm(2) (P < 0.001) after final treatment. Procedural complications were limited to transient no-reflow in five patients. Only one patient evolved a Q-wave MI. At 30 days of follow-up, no patients suffered death, emergent bypass surgery, or stroke. Our data suggest that the adjunctive use of rheolytic thrombectomy offers improved outcomes compared to prior results of intervention after coronary stent thrombosis and should be strongly considered as a treatment option for this complication.
authors.affiliation: Alton Ochsner Medical Institutions, New Orleans, Louisiana, USA. jsilva@ochsner.org
authors.forename: Jose A
authors.initials: JA
authors.lastname: Silva
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: White
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Ramee
authors.forename: Tyrone J
authors.initials: TJ
authors.lastname: Collins
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Jenkins
authors.forename: Kalon
authors.initials: K
authors.lastname: Ho
authors.forename: Donald S
authors.initials: DS
authors.lastname: Baim
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Carrozza
authors.forename: Stephane
authors.initials: S
authors.lastname: Rinfret
authors.forename: Cindy M
authors.initials: CM
authors.lastname: Setum
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Popma
authors.forename: Richard E
authors.initials: RE
authors.lastname: Kuntz
mesh_terms: D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D018056:Hemorheology / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D015607:Stents / Q000009:adverse effects*; D017131:Thrombectomy / Q000009:adverse effects* / Q000379:methods*; D013997:Time Factors