Nakagawa Y, Matsuo S, Kimura T, Yokoi H, Tamura T, Hamasaki N, Nosaka H, Nobuyoshi M
Kokura Memorial Hospital, Kitakyushu, Japan.
Am J Cardiol. 1999 Apr 1;83(7):994-9. doi: 10.1016/s0002-9149(99)00003-x.
The AngioJet thrombectomy catheter removes thrombi by rheolytic fragmentation and suction. The purpose of this study was to identify the efficacy and safety of this new device. Myocardial infarction (MI) is associated with intracoronary thrombus. Intracoronary thrombus has been identified as a risk factor of unfavorable outcome after percutaneous transluminal coronary angioplasty. To what extent the AngioJet is applicable or effective for acute or recent MI in native coronary artery is not clear. Thrombectomy with the AngioJet was attempted in 31 patients with 31 native coronary arteries selected from 304 patients with acute or recent MI. Follow-up angiography was performed at 3 to 6 months. Procedure success was achieved in 29 patients (94%). Adjunctive balloon angioplasty was performed after AngioJet thrombectomy in 30 patients (97%), and in only 1 patient (3%) AngioJet thrombectomy was the sole procedure. Subsequent stenting after balloon angioplasty was attempted successfully in 12 patients (40%) without thrombotic complications. Thrombolysis In Myocardial Infarction trial flow grading increased from 0.70 +/- 0.97 before to 2.61 +/- 0.88 after AngioJet thrombectomy (p <0.0001), to 2.84 +/- 0.64 after adjunctive procedures (p = 0.070). At follow-up angiography restenosis rate was 21% but Thrombolysis In Myocardial Infarction flow 3 was present in all patients. The restenosis rate of stented patients was 8%. There were no major events during in-hospital and follow-up. The AngioJet can be used safely and successfully to remove thrombus from the native coronary artery of patients with MI. Thrombus removal makes subsequent stenting safe and uncomplicated. The restenosis rate was considered to be acceptable.
AngioJet血栓切除术导管通过流体力学破碎和抽吸来清除血栓。本研究的目的是确定这种新装置的有效性和安全性。心肌梗死（MI）与冠状动脉内血栓形成有关。冠状动脉内血栓已被确定为经皮腔内冠状动脉成形术后不良预后的危险因素。目前尚不清楚AngioJet在多大程度上适用于或有效治疗天然冠状动脉的急性或近期心肌梗死。从304例急性或近期心肌梗死患者中选取31例有31条天然冠状动脉的患者，尝试使用AngioJet进行血栓切除术。在3至6个月时进行随访血管造影。29例患者（94%）手术成功。30例患者（97%）在AngioJet血栓切除术后进行了辅助球囊血管成形术，仅1例患者（3%）仅进行了AngioJet血栓切除术。12例患者（40%）在球囊血管成形术后成功尝试了后续支架置入术，无血栓形成并发症。心肌梗死溶栓试验血流分级从AngioJet血栓切除术之前的0.70±0.97增加到术后的2.61±0.88（p<0.0001），辅助手术后增加到2.84±0.64（p=0.070）。随访血管造影时，再狭窄率为21%，但所有患者均存在心肌梗死溶栓试验3级血流。支架置入患者的再狭窄率为8%。住院期间和随访期间均未发生重大事件。AngioJet可安全、成功地用于清除心肌梗死患者天然冠状动脉内的血栓。清除血栓使后续支架置入安全且无并发症。再狭窄率被认为是可以接受的。
