title: Feasibility of sequential thrombus aspiration and filter distal protection in the management of very high thrombus burden lesions.
abstract: BACKGROUND
  A series of thrombectomy and distal filter devices have been developed to limit distal embolization during percutaneous coronary interventions (PCI).
  
  
  OBJECTIVE
  To evaluate the feasibility of the combined use of thrombus-aspirating catheters and distal filter devices in patients at high risk of no-reflow.
  
  
  METHODS
  Thrombus aspiration (TA) and distal filter protection (DFP) were sequentially used in a series of patients undergoing urgent PCI within 48 hours of acute myocardial infarction (MI). Inclusion criteria were: (1) occlusion of the infarct-related artery; (2) at least 2 out of the 6 Yip's classification features of high thrombus burden. Coronary angiograms were evaluated off-line to assess thrombus score, coronary flow and distal embolization in different phases of the procedure.
  
  
  RESULTS
  TA followed by DFP prior to balloon dilatation or stent implantation was successfully performed in 20 patients with acute MI due to occlusion of de novo lesions (80%) or in-stent thrombosis (20%) located in a native coronary artery (90%) or a saphenous vein graft (10%). TA was associated with a significant acute reduction of TS and improvement of coronary flow (TIMI grade from 0.7 +/- 0.8 to 1.6 +/- 1.1; p = 0.004 and CTFC from 83 +/- 29 to 52 +/- 36; p = 0.006). This facilitated the deployment of DFP, which did not induce significant flow modification (TIMI grade: 2.3 +/- 0.9 pre-DFP placement vs. 2.2 +/- 1.0 post-DFP placement; p = 0.20; CTFC: 32 +/- 28 pre-DFP placement vs. 35 +/- 28 post-DFP placement; p = 0.47). Post-PCI angiography revealed a 90% TIMI 3 flow rate and 47% MBG 3 rate with only 1 case of angiographically evident distal embolization.
  
  
  CONCLUSIONS
  Sequential use of TA and DFP may be successfully used during PCI in patients at very high risk of distal embolization. However, the possible benefits of such an approach should be weighted with the increased complexity of the procedure. Further evaluations of the clinical efficacy of this approach are needed.
authors: Catholic University of the Sacred Heart, Cardiology Department, Rome, Italy. f.burzotta@rm.unicatt.it
authors: Francesco
authors: F
authors: Burzotta
authors: Carlo
authors: C
authors: Trani
authors: Enrico
authors: E
authors: Romagnoli
authors: Maria
authors: M
authors: De Vita
authors: Giovanni Paolo
authors: GP
authors: Talarico
authors: Giuseppe
authors: G
authors: Ferrante
authors: Italo
authors: I
authors: Porto
authors: Antonio Maria
authors: AM
authors: Leone
authors: Giampaolo
authors: G
authors: Niccoli
authors: Giovanni
authors: G
authors: Schiavoni
authors: Antonio Giuseppe
authors: AG
authors: Rebuzzi
authors: Rocco
authors: R
authors: Mongiardo
authors: Mario Attilio
authors: MA
authors: Mazzari
authors: Filippo
authors: F
authors: Crea
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002404:Catheterization; D017023:Coronary Angiography; D003326:Coronary Circulation; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D003328:Coronary Thrombosis / Q000150:complications / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D004617:Embolism / Q000209:etiology / Q000517:prevention & control; D005240:Feasibility Studies; D005260:Female; D005374:Filtration / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D012039:Regional Blood Flow; D018570:Risk Assessment; D012501:Saphenous Vein / Q000503:physiopathology / Q000637:transplantation; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects; D013396:Suction / Q000295:instrumentation