Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands.
Neth Heart J. 2010 Sep;18(9):423-9. doi: 10.1007/BF03091809.
Background. In acute myocardial infarction, thrombus aspiration prior to percutaneous coronary interventions (PCI) is often beneficial, but this approach has never been studied in patients without acute myocardial infarction. The aim of this retrospective study is to shed light on that topic based on our initial experience with manual thrombus aspiration in patients with stable or unstable angina pectoris and angiographic evidence of lesion-site thrombus. Methods. We assessed the feasibility (thrombus aspiration without predilatation) of this approach; in addition, we determined angiographic coronary flow and myocardial blush grade. Results. During 33 months in which a total of 4725 PCI were performed in our centre, manual thrombus aspiration was attempted in 14 patients with stable or unstable angina pectoris with angiographic evidence of thrombus. In nine of these 14 patients, the aspiration catheter could be advanced into the lesion without predilatation; in eight patients visible thrombus was obtained. The corrected TIMI frame count improved during the entire interventional procedure (21.1±11.2 vs. 12.8±5.9 frames; p=0.015). Myocardial blush grade, which overall improved during PCI (p<0.001), tended to show greater improvement in patients in whom thrombus aspiration could be achieved (1.6±0.9 vs. 0.7±0.5; p=0.06). Conclusions. Preliminary evidence suggests that manual thrombus aspiration may occasionally be considered in selected patients without acute myocardial infarction but with angiographic evidence of lesion-site thrombus. Nevertheless, prospective studies are required to clearly define the role of this approach in clinical practice. (Neth Heart J 2010;18:423-9.).
背景。在急性心肌梗死患者中，经皮冠状动脉介入治疗（PCI）前进行血栓抽吸通常是有益的，但这种方法从未在没有急性心肌梗死的患者中进行过研究。本回顾性研究旨在根据我们在稳定型或不稳定型心绞痛患者中应用手动血栓抽吸的初步经验，阐明这一话题，这些患者的血管造影均显示病变部位有血栓。
方法。我们评估了这种方法的可行性（不预扩张进行血栓抽吸）；此外，我们还确定了血管造影的冠状动脉血流和心肌灌注分级。
结果。在我们中心进行的 4725 例 PCI 中，共进行了 33 个月，有 14 例稳定型或不稳定型心绞痛患者的血管造影显示有血栓，尝试进行了手动血栓抽吸。在这 14 例患者中，有 9 例可以在不预扩张的情况下将抽吸导管推进病变部位；有 8 例患者获得了可见的血栓。在整个介入过程中，校正的 TIMI 帧数计数均有所改善（21.1±11.2 与 12.8±5.9 帧；p=0.015）。总的来说，心肌灌注分级在 PCI 过程中有所改善（p<0.001），在能够进行血栓抽吸的患者中，这种改善趋势更为明显（1.6±0.9 与 0.7±0.5；p=0.06）。
结论。初步证据表明，在没有急性心肌梗死但有病变部位血栓的血管造影证据的情况下，选择性地对某些患者进行手动血栓抽吸可能是可行的。然而，需要前瞻性研究来明确这种方法在临床实践中的作用。（荷兰心脏杂志 2010；18：423-9.）。
