title: Rheolityc thrombectomy in acute myocardial infarction: Effect on microvascular obstruction, infarct size, and left ventricular remodeling.
abstract: OBJECTIVE
  We sought to analyze whether rheolytic thrombectomy (RT) in comparison with manual thrombus aspiration (MTA) may reduce microvascular obstruction (MVO), infarct size (IS), and left ventricular (LV) remodeling in ST-elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  Conflicting results have been reported as to whether MTA reduces MVO and IS.
  
  
  RESULTS
  Eighty STEMI reperfused by primary angioplasty and abciximab were randomly allocated (1:1) to RT or MTA. Cardiac magnetic resonance imaging (MRI) was performed in 37 patients (19 RT) and after 1 year in 19 (9 RT); baseline, 1- and 6-month 2D-echo was performed in all patients. MVO and IS were measured 8 min after gadolinium injection with late enhancement sequences and were analyzed quantitatively at a core laboratory blinded to randomization. At baseline TIMI thrombus grade were similar (RT: 4.47 ± 0.84 vs. MTA: 4.67 ± 0.76, P = 0.453). After thrombectomy, thrombus grade decreased to 1.11 ± 1.04 in RT vs. 2.17 ± 1.29 in MTA arm (P = 0.009). RT compared with MTA did not reduced significantly myocardial IS [12.2% (6.4-22.1) vs. 19.0% (7-28.5), P = 0.224] as well as the extent of MVO [0.0% (0.0-0.17) vs. 0.6% (0.0-1.4), P = 0.117], but a trend toward a lower incidence of MVO (16% vs. 44%, P = 0.056) and a less LV remodeling rate were found in RT arm (11% vs. 24%, P < 0.140).
  
  
  CONCLUSIONS
  RT in comparison with MTA was more effective in thrombus removal, but it did not reduced significantly the IS and the extent of MVO. However, a trend toward a lower incidence of MVO and a better preservation of LV volumes were found in RT arm. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Nazario
authors.initials: N
authors.lastname: Carrabba
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Parodi
authors.affiliation: Cardiovascular Research Foundation and Columbia University Medical Center, New York, New York.
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.affiliation: Department of Radiology, Careggi Hospital, Florence, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Pradella
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Migliorini
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Valenti
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Comito
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Marrani
authors.affiliation: Department of Radiology, Careggi Hospital, Florence, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Rega
authors.affiliation: Department of Radiology, Careggi Hospital, Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Colagrande
authors.affiliation: Cardiovascular Research Foundation and Columbia University Medical Center, New York, New York.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: David
authors.initials: D
authors.lastname: Antoniucci
mesh_terms: D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011446:Prospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*; D020257:Ventricular Remodeling
keywords: infarct size; microvascular obstruction; primary angioplasty; remodeling; thrombectomy