Rheolytic thrombectomy during percutaneous revascularization for acute myocardial infarction: Experience with the AngioJet catheter

Background Although balloon angioplasty and stenting ore effective in the t reatment of acute myocardial infarction (MI), reduced coronary flow and dis tal embolization frequently complicate interventions when thrombus is prese nt. Adjunctive treatment with mechanical thrombectomy devices may reduce th ese complications. Methods and Results We evaluated the angiographic and clinical outcomes of 70 patients with acute MI (16% with cardiogenic shock) and with angiographi cally evident thrombus who were treated with AngioJet rheolytic thrombectom y followed by immediate definitive treatment. Procedure success (residual d iameter stenosis <50% and Thrombolysis in Myocardial Infarction [TIMI] Flow <greater than or equal to>2 after final treatment) was achieved in 93.8%. Clinical success (procedure success without major in-hospital cardiac event s) was achieved in 87.5%, with an in-hospital mortality rate of 7.1%. Final TIMI 3 flow was achieved in 87.7%. AngioJet treatment resulted in a mean t hrombus area reduction From 73.2 +/- 64.6 mm(2) at baseline to 15.5 +/- 30. 1 post-thrombectomy (P < .001). Subsequent definitive treatment included st enting in 67% and balloon angioplasty alone in 26% of patients. Procedural complications included distal embolization in six patients and perforation in two patients. There were no further major adverse events during 30-day f ollow-up. Conclusion Rheolytic thrombectomy can be performed safely and effectively i n patients with acute MI, allowing far immediate definitive treatment in th rombus-containing lesions.