title: Intracoronary thrombectomy improves myocardial reperfusion in patients undergoing direct angioplasty for acute myocardial infarction.
abstract: OBJECTIVE
  We sought to evaluate the effects of mechanical thrombectomy on myocardial reperfusion during direct angioplasty for acute myocardial infarction (AMI).
  
  
  BACKGROUND
  Embolization of thrombus and plaque debris may occur during direct angioplasty for AMI. This may lead to distal vessel or side branch occlusion and to obstructions in the microvascular system, resulting in impaired myocardial reperfusion. Mechanical thrombectomy is used to reduce distal embolization.
  
  
  METHODS
  Ninety-two patients with AMI and angiographic evidence of intraluminal thrombus were randomized to either intracoronary thrombectomy followed by stenting or to a conventional strategy of stenting. Thrombectomy was performed using the X-Sizer catheter (EndiCOR Inc., San Clemente, California). Myocardial reperfusion was assessed by myocardial blush and ST resolution.
  
  
  RESULTS
  Postprocedure Thrombolysis in Myocardial Infarction-3 flow was not different between groups (93.5% vs. 95.7%, p = 0.39). Myocardial blush-3 was observed in 71.7% of patients undergoing thrombectomy and in 36.9% of patients undergoing conventional strategy (p = 0.006). ST-segment resolution >or=50% occurred more often in patients undergoing thrombectomy (82.6% vs. 52.2%, p = 0.001). By multivariate analysis, adjunctive thrombectomy was an independent predictor of blush-3 (odds ratio, 3.27; 95% confidence interval, 1.06 to 10.05; p = 0.039).
  
  
  CONCLUSIONS
  Intracoronary thrombectomy as adjunct to stenting during direct angioplasty for AMI improves myocardial reperfusion as assessed by myocardial blush and ST resolution.
authors.affiliation: Department of Cardiology, Mirano, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Napodano
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Pasquetto
authors.forename: Salvatore
authors.initials: S
authors.lastname: Saccà
authors.forename: Carlo
authors.initials: C
authors.lastname: Cernetti
authors.forename: Virginia
authors.initials: V
authors.lastname: Scarabeo
authors.forename: Pietro
authors.initials: P
authors.lastname: Pascotto
authors.forename: Bernhard
authors.initials: B
authors.lastname: Reimers
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D003328:Coronary Thrombosis / Q000601:surgery*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D015607:Stents; D017131:Thrombectomy; D013997:Time Factors; D016896:Treatment Outcome