Intracoronary thrombectomy with the export aspiration catheter before angioplasty in patients with ST-segment elevation myocardial infarction.
OBJECTIVE
We aimed to assess the safety and feasibility of thrombectomy with the Export Aspiration Catheter (EAC) before angioplasty, and its ability to improve angiographic results in patients with ST-segment elevation myocardial infarction (STEMI).


BACKGROUND
Distal embolization of atherothrombotic material often occurs during angioplasty in STEMI, compromising optimal myocardial reperfusion.


METHODS
We performed a thrombus-aspiration with EAC prior to angioplasty in 64 consecutive patients with STEMI. Successful thrombectomy was defined as an improvement of TIMI flow grade >or=1.


RESULTS
Successful thrombectomy (increase of TIMI flow >or=1) was achieved in 40 patients (62.5%). Mean TIMI flow grade increased from 0.7 +/- 1 to 1.9 +/- 1.2 (p < 0.0001) after thrombectomy. TIMI flow grade 3 was observed more frequently after EAC compared with guidewire alone (51.5% vs. 9%, p = 0.0062). Direct stenting was performed in most of the patients (n = 41, 64%). Distal embolization and no reflow/slow flow phenomenon occurred in 8 patients (12.5%). No vessel injury after EAC thrombectomy was reported. After treatment with balloon angioplasty and/or stenting, final TIMI flow grade 3 was achieved in 54 patients (84.5%). By multivariate analysis, ischemic time < 6 hours was a significant independent predictor of successful thrombectomy (p = 0.0437).


CONCLUSIONS
Our series suggests that EAC thrombectomy prior to angioplasty in the setting of STEMI is safe and feasible. It might reduce the culprit coronary lesion's thrombus burden, leading to improved flow restoration and myocardial reperfusion. Further large randomized studies are warranted to confirm these preliminary results and to assess the impact of thrombus-aspiration on infarct size as well as on clinical outcomes.
Cohen
Rémy
R
Department of Cardiology, Centre Hospitalier Lagny-Marne-la-Vallée, Lagny-sur-Marne, France. remycohen@hotmail.com
Domniez
Thierry
T
Foucher
Rémi
R
Sfaxi
Anis
A
Elhadad
Simon
S
D000208:Acute Disease; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002404:Catheterization / Q000295:instrumentation*; D017023:Coronary Angiography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D011300:Preoperative Care; D011446:Prospective Studies; D012449:Safety; D017131:Thrombectomy / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome