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Multicenter Study
. 2002 May;87(5):455-60.
doi: 10.1136/heart.87.5.455.

Early experience with a helical coronary thrombectomy device in patients with acute coronary thrombosis

S Constantinides  1 , T S N Lo, M Been, M F Shiu
Affiliations
Multicenter Study

Early experience with a helical coronary thrombectomy device in patients with acute coronary thrombosis

S Constantinides et al. Heart. 2002 May.

Abstract

Objective: To report our experience with a new thrombectomy device (X-SIZER(TM)) in patients with angiographically visible thrombus or total coronary occlusion in the setting of acute coronary syndromes.

Design: A safety and feasibility study in the use of the X-SIZER during intervention in patients with acute coronary syndromes.

Patients: 35 patients, age range 31 to 83 years (mean 60).

Setting: University Hospitals of Coventry and Warwickshire NHS Trust (tertiary referral centre).

Interventions: The indication for intervention was primary or salvage percutaneous coronary intervention for acute myocardial infarction in 17 of the 35 patients; unstable angina or non-ST-elevation myocardial infarction in 10; and unstable postinfarct angina in eight. Abciximab was given in 11 patients.

Main outcome measures: Device success (successful deployment of the device at the site of the lesion with resultant improvement in TIMI flow); clinical success (no residual stenosis at the end of the procedure with no in-hospital major adverse coronary events).

Results: Successful use of the device was achieved in 26 of the 35 cases. It failed to cross the lesion in five and failed to improve TIMI flow despite crossing the lesion in four. Clinical success was achieved in 30 of the 35 cases. Device related complications occurred in two cases (vessel perforation) and there was one intraprocedural death (acute myocardial infarction with cardiogenic shock).

Conclusions: Thrombectomy with the X-SIZER catheter system appears promising in percutaneous coronary intervention where thrombus extraction is considered necessary before stent implantation.

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Figures

Figure 1
Figure 1
Angiographic views during percutaneous coronary intervention in a 70 year old woman presenting with unstable angina pectoris and deep ECG T wave inversion. Left panel: Right anterior oblique view showing thrombus as a filling defect in the left anterior descending coronary artery. Middle panel: Left anterior oblique view showing the thrombus. Right panel: Left anterior oblique view showing marked angiographic improvement following thrombectomy.
Figure 2
Figure 2
Angiographic views during percutaneous coronary intervention in a 61 year old man with unstable angina after an inferior mtocardial infarct, at seven days after the index event. Left panel: Left anterior oblique view of a total right coronary artery occlusion. Middle panel: Left anterior oblique view showing the radiopaque tip of the X-SIZER advancing over the guide wire in the occluded right coronary artery. Right panel: Angiographic appearance in the left anterior oblique view of the recanalised right coronary artery following thrombectomy and stent implantation.
Figure 3
Figure 3
The X-SIZER catheter system consisting of the drive unit, catheter shaft, aspiration tubing with in-line filter and vacuum bottle (not shown). Insert: Schematic representation of the helical cutting tip.
Figure 4
Figure 4
Angiographic views in a 54 year old man presenting with unstable postinfarct angina and previous coronary artery bypass graft 10 years earlier. Right panel: Recent right coronary artery saphenous vein graft occlusion despite guide wire crossing (left anterior oblique projection). Middle panel: Following thrombectomy and balloon angioplasty to distal lesion, TIMI grade 3 flow established with residual thrombus proximally. Right panel: Following repeat thrombectomy and the implantation of intracoronary stents.
Figure 5
Figure 5
Angiographic views during percutaneous coronary intervention in a 74 year old woman with failed thrombolysis following an acute inferior myocardial infarct. Left panel: Left anterior oblique view of the totally occluded right coronary artery on initial diagnostic angiogram. Right panel: After thrombectomy with the X-SIZER catheter, no significant lesion was observed. No stent was implanted. Follow up angiogram at four months showed no significant stenosis.
See this image and copyright information in PMC

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