Forward and back aspiration during ST-elevation myocardial infarction: a feasibility study
| Autor: | Paul K. Wright, Bernard Clarke, Bernard Keavney, Douglas G. Fraser, Hafez A Alhous, David Shelton, Vasim Farooq, Magdi El-Omar, Ahmad H. S. Mustafa, Farzin Fath-Ordoubadi, Durgesh Rana, Patrick W. Serruys, Nadira Narine, Nadim Malik, Mamas A. Mamas, Cara Hendry |
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| Přispěvatelé: | Cardiology |
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Suction 030204 cardiovascular system & hematology Coronary Angiography Balloon 03 medical and health sciences 0302 clinical medicine Coronary thrombosis Coronary Circulation medicine Humans cardiovascular diseases 030212 general & internal medicine Myocardial infarction Thrombus Aged Thrombectomy Aged 80 and over business.industry Coronary Thrombosis Stent Middle Aged medicine.disease Surgery Catheter Treatment Outcome Conventional PCI Feasibility Studies ST Elevation Myocardial Infarction Female Radiology Cardiology and Cardiovascular Medicine business TIMI |
| Zdroj: | EuroIntervention, 11(14), e1639-e1648. EuroPCR |
| ISSN: | 1969-6213 1774-024X |
| DOI: | 10.4244/eijv11i14a315 |
| Popis: | Aims The inability to optimise stent expansion fully whilst simultaneously preventing distal embolisation during ST-elevation myocardial infarction (STEMI) remains a clinical conundrum. We aimed to describe a newly devised angiographic strategy of "forward" and "back" aspiration that leads to more complete thrombus removal and prevention of distal embolisation, to allow high-pressure post-dilatation of the implanted stent to be performed. Methods and results Forward aspiration was conducted with a conventional aspiration thrombectomy catheter, with bail-out aspiration thrombectomy for angiographically persistent thrombus utilising the larger bore 6 Fr (0.056") guide catheter extension system (GuideLiner; Vascular Solutions, Inc., Minneapolis, MN, USA). Back aspiration was undertaken with a deeply intubated GuideLiner or guide catheter with a vacuum induced within, extending to the inflated angioplasty balloon, to allow for proximal embolic protection during balloon deflation during all stages of the PCI procedure, including high-pressure post-dilatation of the stent to the visually estimated reference vessel diameter (RVD). Over a six-month period 30 consecutive cases were undertaken during working hours. Bail-out GuideLiner-assisted aspiration thrombectomy was performed in 9/30 cases because of inadequate thrombus removal with a conventional aspiration thrombectomy catheter. Back aspiration was performed in all cases. In 27/30 cases high-pressure post-dilatation of the stent was performed. The mean maximum post-dilatation balloon size and mean proximal reference vessel diameter did not significantly differ (3.60±0.41 mm vs. 3.65±0.45 mm, p=0.68). In all cases, implantation +/- post-dilatation of the stent to the visually estimated RVD was achievable without any deterioration in TIMI blood flow or myocardial blush grade. Conclusions The strategy of forward and back aspiration to facilitate stent implantation and high-pressure post-dilatation during STEMI appears to be safe and effective. Randomised controlled trials are required to confirm the safety and efficacy of this newly devised angiographic strategy. |
| Databáze: | OpenAIRE |
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