Galiuto Leonarda, Garramone Barbara, Burzotta Francesco, Lombardo Antonella, Barchetta Sabrina, Rebuzzi Antonio G, Crea Filippo
Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
J Am Coll Cardiol. 2006 Oct 3;48(7):1355-60. doi: 10.1016/j.jacc.2006.05.059. Epub 2006 Sep 14.
The aim of this study was to clarify the role of microembolization in the genesis of microvascular obstruction (MO) after percutaneous coronary intervention (PCI).
Fifty consecutive patients entered the myocardial contrast echocardiography (MCE) substudy of the REMEDIA (Randomized Evaluation of the Effect of Mechanical Reduction of Distal Embolization by Thrombus Aspiration in Primary and Rescue Angioplasty) trial, which defined the role of a new thrombus-aspirating device in preventing distal microembolization after PCI.
A total of 25 patients were randomized to be pretreated with thrombus aspiration before PCI of the culprit lesion and 25 received standard PCI. At 24 h, 1 week, and 6 months after PCI, MCE was performed by Sonovue, and real-time imaging was performed by contrast pulse sequencing technology. Regional wall motion score index (WMSI), contrast score index (CSI), endocardial length of wall motion abnormality (WML) and contrast defect (CDL), end-diastolic and end-systolic left ventricular (LV) volumes, and ejection fraction were calculated.
At each time point, in patients treated with a thrombus-aspiration filter device, WMSI, CSI, WML, and CDL were significantly lower and ejection fraction higher (p < 0.05 vs. control patients), whereas LV volumes were slightly but not significantly smaller compared with control patients. In the overall study population, the extent of MO significantly correlated with temporal changes in LV volumes.
Thrombus aspiration used at the time of PCI significantly reduces the extent of MO and myocardial dysfunction, although it does not have a significant favorable effect in preventing LV remodeling. Thus, the beneficial effect of thrombus aspiration occurs at the microvascular level, but additional mechanisms may play a role in influencing the final extent of MO, which strictly correlates with post-infarct LV remodeling.
本研究旨在阐明微栓塞在经皮冠状动脉介入治疗（PCI）后微血管阻塞（MO）发生过程中的作用。
连续50例患者进入REMEDIA（在初次和补救性血管成形术中通过血栓抽吸机械减少远端栓塞效果的随机评估）试验的心肌对比超声心动图（MCE）子研究，该试验确定了一种新型血栓抽吸装置在预防PCI后远端微栓塞中的作用。
总共25例患者被随机分配在对罪犯病变进行PCI前接受血栓抽吸预处理，另外25例接受标准PCI。在PCI后24小时、1周和6个月时，使用声诺维进行MCE，并通过对比脉冲序列技术进行实时成像。计算节段性室壁运动评分指数（WMSI）、对比剂评分指数（CSI）、室壁运动异常的内膜长度（WML）和对比剂缺损（CDL）、舒张末期和收缩末期左心室（LV）容积以及射血分数。
在每个时间点，使用血栓抽吸过滤装置治疗的患者，WMSI、CSI、WML和CDL显著更低，射血分数更高（与对照组患者相比，p<0.05），而与对照组患者相比，LV容积略小但无显著差异。在整个研究人群中，MO的程度与LV容积的时间变化显著相关。
PCI时使用血栓抽吸可显著降低MO的程度和心肌功能障碍，尽管在预防LV重塑方面没有显著的有益效果。因此，血栓抽吸的有益作用发生在微血管水平，但其他机制可能在影响MO的最终程度中起作用，MO的最终程度与梗死后LV重塑密切相关。
