Adjunctive thrombus aspiration and mechanical protection from distal embolization in primary percutaneous intervention for acute myocardial infarction

Primary percutaneous intervention for acute occlusion of a native coronary artery may be complicated by distal embolization of plaque or thrombotic de bris, with infarct extension. We tested the clinical application of a new t herapeutic strategy combining maximal antiplatelet therapy, with glycoprote in IIb/IIIa inhibition, and adjunctive mechanical protection from distal em bolization and direct aspiration of thrombus with a new balloon and cathete r system (PercuSurge(TM)). Successful aspiration of thrombus could be obtai ned in 7 out of 8 attempted procedures, with inability to negotiate the ang ulated take-off of the circumflex coronary artery in one patient. The curre nt mechanical characteristics of the device, primarily developed for use in larger saphenous vein grafts, and certain caveats and limitations are disc ussed. New dedicated systems should be available in the near future for the native coronary circulation. Excellent immediate angiographic results were obtained in all treated patients, without evidence of loss of distal branc hes and no intraprocedural complications. (C) 2000 Wiley-Liss, Inc.