| Popis: |
Coronary thrombus during percutaneous transluminal coronary angioplasty setting is a therapeutic challenge. Coronary thrombus in acute coronary syndromes has been associated with an increase of major adverse cardiac events, which have relationship with distal embolization and "no-reflow" phenomenon. What's just time to take a decision for therapeutic approach of coronary thrombus? Basically, this question it depends of two main factors: clinical condition of the patient and the size of coronary thrombus. Therefore, if the lesion contains small thrombus independently of the clinical condition of the patient it's very sure that the angiographic result will be very adequate with catheter balloon and stenting. However, by the other side if thrombus is large and there was no time for intravenous infusion of IIb-IIIa inhibitors, because of patient unstability (serious arrhythmia or hemodynamic collapse) is recommendable to use some devices of thrombectomy + aspiration with the purpose to diminish thrombus burden and avoid complications of distal embolization and "no-reflow" phenomenon. X-Sizer catheter is a very versatile device who combines purposes of thrombectomy plus aspiration. Our experience in 42 patients with acute coronary syndromes showed that its use is sure and feasible with a very low rate of ischemic complications and TIMI 3 flow restoration in 80% of all patients. Therapeutical approach of coronary thrombus must be based in the experience and the knowledge of some devices for thrombectomy plus aspiration. |
