Prophylactic use of manual thrombectomy in ST-segment elevation myocardial infarction.
OBJECTIVE
We sought to evaluate the effects of manual thrombectomy on myocardial reperfusion performed during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).


BACKGROUND
Complete reperfusion after primary PCI is compromised by the presence of intraluminal thrombus. Thus effective and safe extraction of thrombus in a timely fashion is important for successful reperfusion.


METHODS
Thirty-two patients (age 51+/-12 years, males 78%) with STEMI and angiographic evidence of intraluminal thrombus underwent thrombectomy during an 18-month period. Thrombectomy was performed after the presence of thrombus was confirmed angiographically by the operator either before or after primary angioplasty. Thrombectomy was performed using the 6F Export Aspiration Catheter (Medtronic Corporation, Santa Rosa, CA, USA). Myocardial reperfusion using Thrombolysis in Myocardial Infarction (TIMI) flow and myocardial blush grade was assessed by two independent observers.


RESULTS
The infarct-related artery was left anterior descending (59%), right coronary artery (19%), saphenous venous graft (19%), or left circumflex artery (3%). The coronary lesion was Type B in 62% and Type C in 37% patients, with an average length of 18.2+4.6 mm and reference vessel diameter of 3.2+/-0.4 mm. The preprocedural TIMI flow was 0 in 62%, 1 in 12%, 2 in 22%, and 3 in 3% of patients. The postprocedural TIMI flow was 0 in 3%, 1 in 6%, 2 in 25%, and 3 in 56% of patients. The postprocedural myocardial blush grade was 0 in 6%, 1 in 9%, 2 in 35%, and 3 in 48% of patients. The in-hospital mortality was 0 and the 30-day mortality was 3%.


CONCLUSIONS
Manual thrombectomy using an Export catheter is safe and effective in establishing myocardial reperfusion after STEMI.
Abi-Saleh
Bernard
B
Department of Medicine, Division of Cardiology, University of South Alabama, Mobile, AL 36617, USA. babisaleh@usouthal.edu
Soltani
Peyman
P
Husain
Nadeem M
NM
Ali
Malik
M
Khawaja
Shazib N
SN
Ahmed
S Hinan
SH
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D003326:Coronary Circulation; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013396:Suction / Q000009:adverse effects / Q000401:mortality; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome