Rheolytic thrombectomy and platelet glycoprotein IIb/IIIa blockade for stent thrombosis

Abstract

Conventional transcatheter-based strategies result in good procedural success but poor clinical outcome in the treatment of intracoronary stent thrombosis. A combined approach of mechanical thrombus burden reduction using AngioJet rheolytic thrombectomy with adjunctive glycoprotein (GP) IIb/IIIa antagonists has not been studied. Between July 1998 and August 2000, 15 patients (17 procedures) underwent AngioJet thrombectomy for stent thrombosis at the Beth Israel Deaconess Medical Center. Patients were followed clinically through 6 months following the AngioJet procedure. All patients presented with signs of acute myocardial infarction at a median of 6 days following the original stenting procedure. Most vessels (88%) were occluded at presentation. A GP IIb/IIIa inhibitor was administered during 16 of the 17 procedures. Rheolytic thrombectomy resulted in complete removal of filling defects in all reviewed cases and led to significant improvement in lumen diameter and TIMI flow with reduction in the thrombotic lesion length (all P values < 0.05). Angiographic success (< 30% residual stenosis, TIMI 3 flow) was attained in all but one procedure. No patient required emergent coronary bypass grafting, repeat coronary angioplasty, or died in-hospital. At 6 months, there were no deaths and repeat revascularization was performed in four patients (29%). A combined approach of rheolytic thrombectomy with adjunctive GP IIb/IIIa blockade was highly effective in resolving stent thrombosis and was associated with favorable acute and long-term outcomes.