PERCUTANEOUS ROTATIONAL THROMBECTOMY REDUCES ACUTE REOCCLUSION IN AN ANIMAL-MODEL OF ACUTE CORONARY-THROMBOSIS

This study was designed to compare acute reocclusion rates after treat ment of acute coronary thrombosis with a percutaneous thrombectomy dev ice or standard balloon angioplasty. Our group has previously reported on the rationale and development of a mechanical device for the treat ment of intra-arterial thrombosis. This device removes fibrin from thr ombus, allowing for dissolution of the cellular elements of the thromb us. Theoretically, thrombus removal (as opposed to displacement) might result in a lower rate of acute rethrombosis. The present study utili zes the device percutaneously in the coronary arteries of closed chest swine and compares recanalization and reocclusion rates with standard balloon angioplasty. Twenty-six animals with total thrombotic coronar y occlusions were treated; 13 with each device. Reocclusion rates with the thrombectomy device were significantly reduced at 60 min and 120 min after recanalization (p < 0.02), and the mean time to reocclusion was prolonged by 45 min (p = 0.07). Technical problems included poor h andling characteristics in early prototypes and stress fractures secon dary to improper use. Changes in catheter design and operator protocol s have largely eliminated these problems. We conclude that this study demonstrates the feasibility of percutaneous mechanical thrombectomy i n the coronary arteries and that reocclusion rates after recanalizatio n of thrombotic occlusions compare favorably to standard angioplasty. (C) 1993 Wiley-Liss, Inc.