Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
J Interv Cardiol. 2022 Mar 26;2022:5692964. doi: 10.1155/2022/5692964. eCollection 2022.
Evaluation of the safety and efficacy of the Penumbra device as an adjunct to percutaneous coronary intervention (PCI) in patients with myocardial infarction (MI) and a large thrombus burden that requires thrombectomy.
For patients with acute MI, PCI is the primary reperfusion method. Large thrombus burden has always been a limitation of successful reperfusion. However, the use of current aspiration devices has been associated with an increased incidence of stroke.
We performed a retrospective chart review at the University Hospitals Medical Center in Cleveland. Our study included data from patients who underwent PCI for ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI) assisted by the Penumbra Cat RX device (a wide-lumen thrombus aspiration catheter) between May 2019 and February 2021. The primary outcome was the final thrombolysis in myocardial infarction (TIMI) flow. The secondary endpoints were a composite of adverse cardiac events at 6 months. About 50% of the patients did undergo transfemoral PCI as per preference of individual operators. The Penumbra thrombectomy device can be used both by radial and femoral approach and does not need any different guide catheter use.
TIMI flow 3 was achieved in 111 patients (90.2%). The secondary endpoint occurred in 11 patients (8.9%, 3 MI, 8 heart failure hospitalizations). There were no stroke events or device-related complications. The door-to-balloon time was not affected by usage of the Penumbra device. Failure in the restoration of TIMI 3 flow was associated with the use of balloon angioplasty prior to the application of the Penumbra device, leading to distal embolization.
The Penumbra Cat RX provides safe and effective thrombus removal with better clinical outcomes, even in high-risk patients with acute coronary syndrome.
评估 Penumbra 装置在需要血栓切除术的心肌梗死（MI）和大量血栓负荷的患者中作为经皮冠状动脉介入治疗（PCI）辅助治疗的安全性和疗效。
对于急性 MI 患者，PCI 是主要的再灌注方法。大的血栓负荷一直是成功再灌注的限制因素。然而，目前使用的抽吸装置与中风发生率增加有关。
我们在克利夫兰大学医院医疗中心进行了回顾性病历审查。我们的研究包括 2019 年 5 月至 2021 年 2 月期间接受 Penumbra Cat RX 装置（一种宽腔血栓抽吸导管）辅助 PCI 治疗的 ST 段抬高型心肌梗死（STEMI）和非 ST 段抬高型心肌梗死（NSTEMI）患者的数据。主要结局是最终心肌梗死溶栓（TIMI）血流。次要终点是 6 个月时不良心脏事件的综合结果。大约 50%的患者按照术者的个人偏好进行经股动脉 PCI。Penumbra 血栓切除术装置可以通过桡动脉和股动脉途径使用，不需要使用不同的引导导管。
111 例患者（90.2%）达到 TIMI 血流 3 级。次要终点发生在 11 例患者（8.9%，3 例心肌梗死，8 例心力衰竭住院）。无中风事件或器械相关并发症。Penumbra 装置的使用并未影响门球时间。TIMI 3 级血流恢复失败与在应用 Penumbra 装置之前使用球囊血管成形术有关，导致远端栓塞。
即使在急性冠状动脉综合征的高危患者中，Penumbra Cat RX 也能提供安全有效的血栓清除，并带来更好的临床结局。
