Kaplan B M, Larkin T, Safian R D, O'Neill W W, Kramer B, Hoffmann M, Schreiber T, Grines C L
Department of Medicine, William Beaumont Hospital, Royal Oak, Michigan.
Am J Cardiol. 1996 Aug 15;78(4):383-8. doi: 10.1016/s0002-9149(96)00323-2.
Although percutaneous transluminal coronary angioplasty (PTCA) has been an effective treatment for primary reperfusion in acute myocardial infarction, patients with thrombolytic ineligibility, thrombolytic failure, cardiogenic shock, and vein graft occlusion remain at high risk for complications with PTCA treatment. The transluminal extraction catheter may be useful for treatment for such patients owing to its ability to aspirate thrombus. At 2 clinical centers, extraction atherectomy was prospectively evaluated in 100 patients (age 62 +/- 10 years). High-risk features included thrombolytic failure in 40%, postinfarct angina in 28%, presence of angiographic thrombus in 66%, presence of cardiogenic shock in 11%, and a saphenous vein graft occlusion in 29%. Procedural success, defined as a final residual stenosis <50% and Thrombolysis in Myocardial Infarction 2 or 3 grade flow, was seen in 94%. Events during the hospitalization included death in 5%, bypass surgery in 4%, and blood transfusion in 18%. In a substudy, patients enrolled at William Beaumont Hospital (n = 65) underwent elective predischarge angiography, which revealed a patent infarct-related vessel in 95%. These patients were also followed for 6 months with angiographic follow-up in 60%. Target vessel revascularization was necessary in 38%, and 6-month mortality was 10%. Although long-term vessel patency was 90%, angiographic restenosis occurred in 68%. Acute myocardial infarction patients can be treated with extraction atherectomy with a high technical success rate and a low incidence of complication. Infarct artery patency at 1 week and 6 months was excellent; however, angiographic restenosis remains a problem. Extraction of thrombus in this high-risk group of patients is associated with low in-hospital mortality and a high rate of vessel patency at 6 months.
尽管经皮腔内冠状动脉成形术（PTCA）一直是急性心肌梗死患者进行初次再灌注的有效治疗方法，但存在溶栓禁忌、溶栓失败、心源性休克以及静脉移植物闭塞的患者接受PTCA治疗时并发症风险仍很高。腔内血栓抽吸导管因其能够抽吸血栓，可能对此类患者的治疗有用。在2个临床中心，对100例患者（年龄62±10岁）进行了前瞻性的血栓旋切术评估。高危特征包括40%的患者溶栓失败、28%的患者梗死后心绞痛、66%的患者存在血管造影显示的血栓、11%的患者存在心源性休克以及29%的患者存在大隐静脉移植物闭塞。手术成功定义为最终残余狭窄<50%且心肌梗死溶栓治疗血流达2级或3级，94%的患者达到此标准。住院期间的事件包括5%的患者死亡、4%的患者接受搭桥手术以及18%的患者输血。在一项子研究中，在威廉·博蒙特医院入组的患者（n = 65）接受了择期出院前血管造影，结果显示95%的患者梗死相关血管通畅。这些患者还进行了6个月的随访，其中60%的患者接受了血管造影随访。38%的患者需要进行靶血管血运重建，6个月死亡率为10%。尽管长期血管通畅率为90%，但68%的患者出现了血管造影再狭窄。急性心肌梗死患者可通过血栓旋切术进行治疗，技术成功率高且并发症发生率低。1周和6个月时梗死动脉通畅情况良好；然而，血管造影再狭窄仍然是一个问题。在这组高危患者中进行血栓抽吸与较低的住院死亡率以及6个月时较高的血管通畅率相关。
