Rheolityc thrombectomy in acute myocardial infarction: Effect on microvascular obstruction, infarct size, and left ventricular remodeling.

Abstract

OBJECTIVES:

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.

METHODS AND 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).

CONCLUSION:

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: Nazario Carrabba, Guido Parodi, Akiko Maehara, Silvia Pradella, Angela Migliorini, Renato Valenti, Vincenzo Comito, Marco Marrani, Luigi Rega, Stefano Colagrande, Gary S Mintz, David Antoniucci
• Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 87 Issue 1 Pg. E1-8 (Jan 01 2016) ISSN: 1522-726X [Electronic] United States
• PMID: 26108162 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © 2015 Wiley Periodicals, Inc.

Topics

• Coronary Angiography
• Coronary Circulation (physiology)
• Coronary Vessels (diagnostic imaging, physiopathology)
• Electrocardiography
• Female
• Follow-Up Studies
• Humans
• Magnetic Resonance Imaging, Cine (methods)
• Male
• Microcirculation
• Middle Aged
• Prospective Studies
• ST Elevation Myocardial Infarction (diagnosis, physiopathology, therapy)
• Thrombectomy (methods)
• Time Factors
• Treatment Outcome
• Ventricular Function, Left (physiology)
• Ventricular Remodeling