AngioJet Rheolytic thrombectomy during rescue PCI for failed thrombolysis: a single-center experience.

BACKGROUND: Previous studies have shown the efficacy of AngioJet Rheolytic Thrombectomy (RT) in reducing thrombus burden and improving coronary flow in acute myocardial infarction (MI). No study has specifically evaluated the use of AngioJet RT in patients undergoing rescue percutaneous coronary intervention (PCI) for failed thrombolysis, a setting that may be particularly beneficial given the extensive thrombus burden. The objective of this study was to evaluate the efficacy and safety of AngioJet RT during rescue PCI for failed thrombolysis. METHODS: 214 consecutive patients were transferred to Good Samaritan Hospital to undergo rescue PCI for failed thrombolysis from January 2000 to October 2004. From this cohort, 32 patients (age 57 +/- 9, 30% male) undergoing AngioJet RT for rescue PCI (RT group) were identified and matched by initial thrombolysis in MI (TIMI) flow and infarct related artery (IRA) location to 32 patients (age 60 +/- 12, 24% male) undergoing rescue PCI without AngioJet RT (Control group). TIMI frame count and TIMI thrombus grade were assessed at initial and final angiography. Angiographic success (TIMI 3 flow, < 50% residual stenosis) and in-hospital clinical events, including bleeding complications and major adverse cardiac events (MACE) such as death, recurrent MI, target vessel revascularization and emergent bypass surgery were evaluated. Clinical success was defined as angiographic success in the absence of MACE. RESULTS: Baseline clinical characteristics were similar in both groups, except patients undergoing AngioJet RT were more likely to be males and less likely to be intubated on transfer. 30/32 (94%) patients achieved a TIMI thrombus grade of 0 in the RT group, compared to 22/32 (69%) in the Control group. Final IRA TIMI frame count was similar in the RT compared to the Control group (33 +/- 21 vs. 38 +/- 23, p NS, respectively). The occurrence of no reflow was significantly lower in the RT compared to the Control group (13% vs. 56%, p < 0.001, respectively). There was a trend for higher angiographic success in the RT compared to the control group (93% vs. 78%, p = 0.07, respectively). Clinical success was higher in the RT compared to the Control group (91% vs. 71%, p = 0.05, respectively). There were no differences in bleeding complications or MACE between the groups. CONCLUSION: AngioJet RT in high-risk patients undergoing rescue PCI for failed thrombolysis is safe and more effective in decreasing thrombus burden and preventing no reflow than conventional PCI.

Angiographic predictors of femoral access site complications: implication for planned percutaneous coronary intervention.

This study examined the relationship between the femoral arteriotomy location and the risk of femoral access site complications after diagnostic and interventional cardiac catheterization procedures. One of the most common complication of cardiac catheterization and percutaneous coronary intervention (PCI) involves the vascular access site. The femoral approach is the most frequent site of vascular access during invasive cardiac procedures. This approach is associated with vascular complications, such as retroperitoneal bleeding, which can be life-threatening. If angiographic predictors of retroperitoneal bleeding can be identified, this complication could be avoided. A prospective cohort of 33 patients with femoral access site complications was subgrouped based on the angiographic arteriotomy site. Concurrent patients without complications were randomly selected to form a control group. Study and control patients were compared on presenting risk factors and outcomes. Logistic regression analysis was used to identify independent predictors for femoral access site complications. Arteriotomy location above the most inferior border of the inferior epigastric artery in patients undergoing PCI was associated with 100% of all retroperitoneal bleeds (P < 0.001). Low, high middle, and high femoral arteriotomy sites were associated with 71% of all vascular access complications. The combination of these locations for the femoral arteriotomy was an independent predictor of adverse vascular access site complications beyond traditional risk factors (odds ratio = 28.7; CI = 6.73-122.40; P < 0.0001). Vascular complications occurred more frequently in patients who were of older age (72 vs. 66 years; P < 0.001). The location of the femoral arteriotomy site assessed by a femoral angiogram is predictive of life-threatening complications. Patients undergoing PCI with an arteriotomy above the most inferior border of the inferior epigastric artery are at an increased risk for retroperitoneal bleeding. This complication may be avoided by risk-stratifying patients prior to intervention with a femoral angiogram.

Pseudo-cross-stimulation due to first degree AV block.

During routine interrogation of a dual chamber pacemaker, atrial pacing stimulus outputs were found to coincide with surface electrogram QRS complexes raising concern for cross-stimulation. Scrutiny of the native rhythm, however, confirmed this to be "pseudo-cross-stimulation" where marked first degree AV block resulted in alignment of atrial stimulus outputs with preceding QRS complexes. Although cross-stimulation is rare, familiarity with cross-stimulation and pseudo-cross-stimulation is important because its recognition will avoid erroneous diagnoses of lead dislodgment or device malfunction.