AngioJet Rheolytic thrombectomy during rescue PCI for failed thrombolysis: a single-center experience.
BACKGROUND
Previous studies have shown the efficacy of AngioJet Rheolytic Thrombectomy (RT) in reducing thrombus burden and improving coronary flow in acute myocardial infarction (MI). No study has specifically evaluated the use of AngioJet RT in patients undergoing rescue percutaneous coronary intervention (PCI) for failed thrombolysis, a setting that may be particularly beneficial given the extensive thrombus burden. The objective of this study was to evaluate the efficacy and safety of AngioJet RT during rescue PCI for failed thrombolysis.


METHODS
214 consecutive patients were transferred to Good Samaritan Hospital to undergo rescue PCI for failed thrombolysis from January 2000 to October 2004. From this cohort, 32 patients (age 57 +/- 9, 30% male) undergoing AngioJet RT for rescue PCI (RT group) were identified and matched by initial thrombolysis in MI (TIMI) flow and infarct related artery (IRA) location to 32 patients (age 60 +/- 12, 24% male) undergoing rescue PCI without AngioJet RT (Control group). TIMI frame count and TIMI thrombus grade were assessed at initial and final angiography. Angiographic success (TIMI 3 flow, < 50% residual stenosis) and in-hospital clinical events, including bleeding complications and major adverse cardiac events (MACE) such as death, recurrent MI, target vessel revascularization and emergent bypass surgery were evaluated. Clinical success was defined as angiographic success in the absence of MACE.


RESULTS
Baseline clinical characteristics were similar in both groups, except patients undergoing AngioJet RT were more likely to be males and less likely to be intubated on transfer. 30/32 (94%) patients achieved a TIMI thrombus grade of 0 in the RT group, compared to 22/32 (69%) in the Control group. Final IRA TIMI frame count was similar in the RT compared to the Control group (33 +/- 21 vs. 38 +/- 23, p NS, respectively). The occurrence of no reflow was significantly lower in the RT compared to the Control group (13% vs. 56%, p < 0.001, respectively). There was a trend for higher angiographic success in the RT compared to the control group (93% vs. 78%, p = 0.07, respectively). Clinical success was higher in the RT compared to the Control group (91% vs. 71%, p = 0.05, respectively). There were no differences in bleeding complications or MACE between the groups.


CONCLUSIONS
AngioJet RT in high-risk patients undergoing rescue PCI for failed thrombolysis is safe and more effective in decreasing thrombus burden and preventing no reflow than conventional PCI.
Sherev
Dimitri A
DA
Division of Cardiology, Good Samaritan Hospital, Los Angeles, California 90017, USA.
Shavelle
David M
DM
Abdelkarim
Murrad
M
Shook
Thomas
T
Mayeda
Guy S
GS
Burstein
Steven
S
Matthews
Ray V
RV
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D015331:Cohort Studies; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy*; D016879:Salvage Therapy; D017131:Thrombectomy / Q000379:methods*; D015912:Thrombolytic Therapy; D017211:Treatment Failure; D016896:Treatment Outcome