Feasibility of primary clot extraction prior to percutaneous coronary intervention in acute myocardial infarction.
OBJECTIVE
To test the feasibility, safety, and in-hospital outcomes of utilizing the FilterWire EZ to extract clot prior to percutaneous coronary intervention (PCI) in patients presenting with acute myocardial infarction (MI).


BACKGROUND
PCI in patients with acute MI is associated with a higher incidence of distal embolization, no-reflow, or slow flow partly due to the presence of clot burden.


METHODS
The authors describe the feasibility, safety, and outcomes of using a FilterWire EZ distal protection device as a clot extraction device in patients who presented with acute MI and documented clot on coronary angiography.


RESULTS
Fifteen consecutive male patients with a mean age of 54 +/- 8 years presented with acute MI (60% ST elevation MI). MI involved left anterior descending artery (n = 4), circumflex artery (n = 3), and right coronary artery (n = 8). Clot extraction followed by PCI reduced the percent diameter stenosis from 94 +/- 12 to 65 +/- 11 (P < 0.001) and restored TIMI 3 flow in all patients without distal embolization. The angiographic, procedural, and clinical success rates were 100%. The mean left ventricular ejection fraction (LVEF) was 52 +/- 8% (range 30-62%) with only three patients (15%) who had an LVEF <50% and five patients (33%) without apparent wall motion abnormalities on echocardiography.


CONCLUSIONS
Clot extraction before PCI during acute MI in native coronaries is feasible, safe, and effective in restoring TIMI 3 flow without distal embolization. Whether this approach results in better outcomes and improved LV function compared with standard therapy alone requires further investigation.
Aqel
Raed
R
VA Tertiary Hospital/Birmingham, University of Alabama at Birmingham, USA. raed.aqel@va.gov
Zoghbi
Gilbert
G
Hage
Fadi
F
Philips
George
G
Perry
Gilbert
G
Iskandrian
Ami
A
Dell'Italia
Louis
L
D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003326:Coronary Circulation; D003328:Coronary Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D004867:Equipment Design; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012720:Severity of Illness Index; D013318:Stroke Volume; D017131:Thrombectomy / Q000009:adverse effects / Q000295:instrumentation; D016896:Treatment Outcome; D016277:Ventricular Function, Left