Makaryus Amgad N, Garyali Samir, Day Gina, Labana Subir S, Park Chong, Kaplan Barry, Jauhar Rajiv
North Shore-Long Island Jewish Health System, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA.
J Interv Cardiol. 2006 Apr;19(2):135-40. doi: 10.1111/j.1540-8183.2006.00120.x.
Rheolytic thrombectomy has been used successfully to treat acutely occluded lower-limb vessels, dialysis grafts, intrahepatic portosystemic shunts, and diseased native coronary vessels and saphenous vein grafts. Few studies, however, have examined the efficacy of rheolytic thrombectomy in the acute myocardial infarction (AMI) setting. We sought to determine the efficacy of the AngioJet Rheolytic thrombectomy catheter (Possis Medical, Minneapolis, MN, USA) in patients presenting with AMI either before or after 12 hours of onset of symptoms.
Procedural and angiographic data on 61 consecutive patients (January 2003-December 2003) who presented with an AMI and had rheolytic thrombectomy with the AngioJet catheter performed were reviewed. Coronary flow was assessed with thrombolysis in myocardial infarction (TIMI) frame counts (TFCs). Of the 61 patients studied, 40 had AngioJet performed within 12 hours and 21 had it done after 12 hours from the onset of symptoms. Procedural success was measured by TFCs measured before and after the procedure and was defined as a change in the TFC of >or=50%. Statistical significance was considered at a P value of <0.05.
Procedural success was achieved in 75% of the patients in the early presentation group (within 12 hours) and 0% of the patients in the late presentation group (after 12 hours). TFC values were statistically different (P<0.001) in the early group, but not significant (P>0.1) in the late thrombectomy group.
Rheolytic thrombectomy with the AngioJet catheter is more effective in terms of improvement in coronary blood flow as assessed by TFCs when used less than 12 hours after the onset of clinical symptoms suggestive of AMI.
流变血栓切除术已成功用于治疗急性闭塞的下肢血管、透析移植物、肝内门体分流术、病变的自身冠状动脉血管和大隐静脉移植物。然而，很少有研究探讨流变血栓切除术在急性心肌梗死（AMI）情况下的疗效。我们试图确定美国明尼阿波利斯市Possis Medical公司生产的AngioJet流变血栓切除术导管在症状发作12小时之前或之后出现AMI的患者中的疗效。
回顾了2003年1月至2003年12月连续61例出现AMI并使用AngioJet导管进行流变血栓切除术患者的手术和血管造影数据。采用心肌梗死溶栓治疗（TIMI）帧数（TFC）评估冠状动脉血流。在研究的61例患者中，40例在症状发作12小时内进行了AngioJet手术，21例在症状发作12小时后进行了该手术。通过手术前后测量的TFC来衡量手术成功率，定义为TFC变化≥50%。P值<0.05时认为具有统计学意义。
早期就诊组（12小时内）75%的患者手术成功，晚期就诊组（12小时后）0%的患者手术成功。早期组TFC值有统计学差异（P<0.001），而晚期血栓切除术组无统计学意义（P>0.1）。
当在提示AMI的临床症状发作后12小时内使用时，AngioJet导管进行的流变血栓切除术在改善冠状动脉血流方面更有效，这通过TFC评估得出。
