REMOVAL OF THROMBUS FROM AORTOCORONARY BYPASS GRAFTS AND CORONARY-ARTERIES USING THE 6FR HYDROLYSER

This study evaluates the feasibility and safety of a 6Fr hydrodynamic thrombectomy catheter, the Hydrolyser, in native coronary arteries and aortocoronory bypass grafts. With use of a conventional contrast inje ctor, saline solution is injected into the narrow lumen of the cathete r which makes a 180 degrees bend at the tip. The resultant high-veloci ty jet (150 km/hour) is directed over a sidehole near the tip into a w ide exhaust lumen. As a consequence of the Venturi effect, thrombus is sucked into that sidehole, fragmented, and removed through the wide e xhaust lumen into a collection bag. Thirty-one thrombotic lesions were treated in 31 patients. The culprit vessel was a veneers graft in 21 patients (15 with Thrombolysis in Myocardial Infarction Trial [TIMI] g rade 0 or 1 flow) and a coronary artery in 11 patients (9 with grade 0 or 1 flow). Twenty-six patients had angina New York Heart Association functional class III or IV heart failure and 5 an acute myocardial in farction. In 26 pattients, Hydrolyser therapy was the primary treatmen t, whereas in 5 patients coronary angioplasty preceded Hydrolyser ther apy. In 1 patient the Hydrolyser could not reach the lesion. Thrombus was removed in 29 of the 31 patients. Successful reperfusion (TIMI gra de 2 or 3 flow) by Hydrolyser therapy alone was achieved in 14 of the 24 patients with TIMI grade 0 or 1 flow before the procedure. Adjuncti ve therapy (coronary angioplasty, stent, or thrombolysis) was performe d in 28 of the 31 patients, At the end of the total procedure 24 patie nts had TlMI grade 3 flow. Distal embolization during thrombectomy occ urred in 2 patients, which led to a non-Q-wave infarction in 1. No pat ient died or needed emergency coronary bypass due to the Hydrolyser pr ocedure. Thus, thrombectomy using the 6Fr Hydrolyser is feasible and w as performed safely in 31 patients, (C) 1997 by Excerpta Medica, Inc.