Feasibility of sequential thrombus aspiration and filter distal protection in the management of very high thrombus burden lesions.
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.
Burzotta
Francesco
F
Catholic University of the Sacred Heart, Cardiology Department, Rome, Italy. f.burzotta@rm.unicatt.it
Trani
Carlo
C
Romagnoli
Enrico
E
De Vita
Maria
M
Talarico
Giovanni Paolo
GP
Ferrante
Giuseppe
G
Porto
Italo
I
Leone
Antonio Maria
AM
Niccoli
Giampaolo
G
Schiavoni
Giovanni
G
Rebuzzi
Antonio Giuseppe
AG
Mongiardo
Rocco
R
Mazzari
Mario Attilio
MA
Crea
Filippo
F
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