Vlaar Pieter J, Diercks Gilles F, Svilaas Tone, Vogelzang Mathijs, de Smet Bart J, van den Heuvel Ad F, Anthonio Rutger L, Jessurun Gillian A, Tan Eng-Shiong, Suurmeijer Albert J, Zijlstra Felix
Department of Cardiology, University Medical Centre Groningen, University of Groningen, Thoraxcenter, Groningen, The Netherlands.
Catheter Cardiovasc Interv. 2008 Dec 1;72(7):937-42. doi: 10.1002/ccd.21717.
To investigate the feasibility and safety of manual thrombus aspiration in patients undergoing percutaneous coronary intervention (PCI) for non-ST-elevation myocardial infarction (NSTEMI).
Myocardial necrosis in patients with acute coronary syndromes may be a sign of microvascular obstruction, owing to spontaneous or PCI-induced embolization of atherothrombotic material. Manual thrombus aspiration results in improved myocardial reperfusion in patients undergoing PCI for ST-elevation myocardial infarction. Currently, no published data on thrombus aspiration in patients with NSTEMI are available.
As part of a prospective cohort study, 70 patients undergoing PCI for NSTEMI were treated with thrombus aspiration (Export Aspiration Catheter, Medtronic, Minneapolis, MN). Histopathological analysis was performed on aspirated material.
Thrombus aspiration was effective in 58 patients (83%) and resulted in a marked reduction of TIMI-thrombus score 4/5 (40% pre- versus 7% postthrombus aspiration) and increase of the rate of TIMI-flow 3 (36% pre- versus 66% postthrombus aspiration). The incidence of myocardial blush grade 2 and 3 were 39 and 45%, respectively. Distal embolization was visible in three patients (4%) on the final angiogram.
This study demonstrates that thrombus aspiration in most NSTEMI patients is feasible and safe and is associated with a high rate of retrieval of thrombotic material.
探讨在接受经皮冠状动脉介入治疗（PCI）的非ST段抬高型心肌梗死（NSTEMI）患者中进行手动血栓抽吸的可行性和安全性。
急性冠状动脉综合征患者的心肌坏死可能是微血管阻塞的迹象，这是由于动脉粥样硬化血栓形成物质的自发或PCI诱导的栓塞所致。对于接受PCI治疗的ST段抬高型心肌梗死患者，手动血栓抽吸可改善心肌再灌注。目前，尚无关于NSTEMI患者血栓抽吸的已发表数据。
作为一项前瞻性队列研究的一部分，70例接受NSTEMI PCI治疗的患者接受了血栓抽吸（美敦力公司，明尼阿波利斯，MN，Export抽吸导管）。对抽吸物进行组织病理学分析。
血栓抽吸在58例患者（83%）中有效，导致TIMI血栓评分显著降低（血栓抽吸前为4/5，即40%，血栓抽吸后为7%），TIMI血流3级发生率增加（血栓抽吸前为36%，血栓抽吸后为66%）。心肌 blush分级2级和3级的发生率分别为39%和45%。在最终血管造影中，3例患者（4%）可见远端栓塞。
本研究表明，大多数NSTEMI患者进行血栓抽吸是可行和安全的，并且与血栓物质的高回收率相关。
