Manual versus nonmanual thrombectomy in primary and rescue percutaneous coronary angioplasty.

Although many thrombectomy devices have been tested in ST-segment elevation acute myocardial infarction (STEMI), there are no comparative data on safety or effectiveness in thrombectomy or ST-segment resolution. This study compares manual versus nonmanual thrombectomy devices in patients undergoing primary or rescue percutaneous coronary intervention in a tertiary care center. We identified 232 consecutive patients with STEMI and time from symptom onset to emergency room contact of < or = 12 h undergoing percutaneous coronary intervention with coronary thrombectomy devices. Primary end point was ST-segment resolution of > or = 70%. Several angiographic, procedural and clinical secondary end points were also evaluated. The manual thrombectomy group included 110 patients and the nonmanual group 122 patients. Both groups were similar in their clinical characteristics. The primary end point occurred with similar frequency in patients treated with manual versus nonmanual thrombectomy (67.9% vs 60.0%, P = 0.216). No significant differences were found in the two groups with regard to procedural complications, angiographic reperfusion parameters, in-hospital major adverse cardiac events, or infarct size, whereas manual thrombectomy was associated with a better left ventricle ejection fraction at discharge. Furthermore, treatment with a manual thrombectomy device was associated with significantly shorter procedural times (69 min vs 95 min, P < 0.001) and lower procedural costs (2981 euros vs 7505 euros, P < 0.001). The use of manual thrombus-aspiration catheters appeared equivalent to nonmanual thrombectomy devices in the setting of primary or rescue percutaneous intervention in terms of clinical efficacy, and led to shorter procedures and cost savings.

Immediate and midterm follow-up results of excimer laser application in complex percutaneous coronary interventions: Report from a single center experience.

OBJECTIVE: To assess the efficacy and safety of laser-assisted percutaneous coronary interventions (PCI) in an unselected population. METHODS: One hundred consecutive patients, who underwent a laser assisted PCI between January 2008 and March 2012, were included in the present study. Fifty-one patients underwent laser ablation for thrombus vaporization (Group 1), 36 patients for neointima/plaque debulking (Group 2) and 13 patients for lesion compliance modification in calcified lesions (Group 3). RESULTS: The rate of in-hospital serious events was 2%. The cumulative laser success was 82%, and it was significantly higher for Group 1 and Group 2 in comparison with Group 3 (p = 0.001). Furthermore, the need for repeat revascularization was significantly higher in the Group 3 compared with the others two groups (46% vs. 8% for Group 1 and 11% for Group 2, p = 0.03). The MACE rate was 14%. There was a trend toward a higher MACE rate in the Group 3 compared with others two groups (p = 0.05). CONCLUSIONS: Laser ablation is an effective and safe tool for complex PCI. Patients underwent laser for thrombus vaporization or for neointima/plaque debulking had better immediate success and better outcome at follow-up than patients underwent laser for lesion compliance modification.

[Manual thrombus aspiration with the Export catheter during primary and rescue angioplasty. Predictors of failed myocardial reperfusion]. / Trombo-aspirazione manuale con catetere Export nell'angioplastica primaria e di salvataggio. Predittori di mancata riperfusione miocardica.

BACKGROUND: Manual thrombus aspiration seems to improve myocardial reperfusion after coronary angioplasty in patients with ST-elevation acute coronary syndrome. We sought to assess the independent variables of complete myocardial reperfusion after primary and rescue coronary angioplasty with use of the Export manual thrombus aspiration catheter. METHODS: Myocardial reperfusion were judged complete if ST-segment resolution were >70% at 60 min post-procedure ECG. Sixty-three consecutive patients undergoing primary (81%) or rescue angioplasty (19%) with use of the Export catheter were analyzed. RESULTS: Forty-three (68%) patients had a complete myocardial reperfusion and 20 (32%) patients did not. The independent predictors of failed myocardial reperfusion, at multivariate analysis, were: heart rate at hospital admission (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.01-1.09; p = 0.007), time to angioplasty >3 h (OR 6.07; 95% CI 1.31-27.97; p = 0.005), left anterior descending coronary artery involvement (OR 8.8; 95% CI 2.12-36.4; p = 0.003). CONCLUSIONS: The present study shows that in the setting of primary or rescue angioplasty with use of Export manual thrombus aspiration catheter, patients with high heart rate on admission, an ischemic time >3 h and left anterior descending coronary artery involvement are at higher risk of failed myocardial reperfusion.