Rheolytic thrombectomy with Angiojet in thrombus-containing lesions.

The AngioJet thrombectomy device removes thrombus by creating a negative pressure and causing fragmentation of the thrombus. The objective was to study the safety and efficacy of this thrombectomy device during coronary interventions and to report the results of our experience. We studied 72 patients (mean age, 64.9 +/- 12.6 years; 79% males) who had an AngioJet procedure during coronary intervention; 33 (46%) had vein graft intervention. All patients had angiographic thrombus. Most patients presented either with unstable angina (54%) or acute myocardial infarction (32%) within 24 hr. The procedural success was high with AngioJet (93%). TIMI grade 3 flow was achieved in 79% of lesions treated with AngioJet. In-hospital mortality was 1.4%, death/Q-wave myocardial infarction was 4.2%, and the composite endpoint of death and Q-wave myocardial infarction/revascularization was 5.6% for patients undergoing AngioJet. Subgroup analysis of patients with vein graft intervention demonstrated high procedural success in those undergoing AngioJet (91%). At 1-year follow-up of the successful percutaneous interventions with AngioJet, the mortality, death/Q-myocardial infarction, and composite endpoint rates were 10%, 13.3%, and 35.5%, respectively. Long-term event-free survival was worse in vein graft interventions. The incidence of death, death/myocardial infarction, or composite endpoints at 1 year was 16%, 19%, and 46%, respectively. High procedural success can be achieved with the AngioJet thrombectomy device in lesions containing thrombus. It is effective in both native coronary arteries and vein graft interventions. However, the long-term outcome of patients with vein graft intervention was worse.