AngioJet Rheolytic Thrombectomy During Rescue PCI for Failed Thrombolysis: A Single-Center Experience

Dimitri A. Sherev, MD, David M. Shavelle, MD, Murrad Abdelkarim, MD, Thomas Shook, MD, Guy S. Mayeda, MD, Steven Burstein, MD, Ray V. Matthews, MD
Dimitri A. Sherev, MD, David M. Shavelle, MD, Murrad Abdelkarim, MD, Thomas Shook, MD, Guy S. Mayeda, MD, Steven Burstein, MD, Ray V. Matthews, MD
Percutaneous coronary intervention (PCI) for acute myocardial infarction (MI) in the setting of angiographic thrombus is associated with an increased risk of reocclusion and recurrent infarction.1,2 Distal embolization of thrombus during PCI is thought to be a major contributor to impaired tissue level perfusion. Previous studies have shown the efficacy of AngioJet Rheolytic Thrombectomy (Possis Medical, Minneapolis, Minnesota) in reducing thrombus burden and improving coronary flow.3,4 However, no study to date has specifically evaluated the use of AngioJet Rheolytic Thrombectomy (RT) in patients undergoing rescue PCI for failed thrombolytics. Given the high thrombus burden in this setting, AngioJet RT would be expected to be particularly useful and associated with marked improvements in thrombus burden and coronary flow. The objectives of this study were to characterize the safety and efficacy and to perform a detailed angiographic analysis of AngioJet RT in patients undergoing rescue PCI for failed thrombolysis. Methods Study population. Two hundred and fourteen consecutive patients were transferred to Good Samaritan Hospital in Los Angeles, California from January 2000 through October 2004 to undergo rescue PCI for failed thrombolysis. The definition of failed thrombolysis was established on clinical grounds and made by the referring physician. All patients had ongoing chest pain, continued ST-segment elevation, hemodynamic instability or malignant ventricular arrhythmias and required transfer for emergent coronary angiography. All patients (n = 214) underwent emergent coronary angiography within 6 hours of arrival. Thirty-two patients (15%) underwent AngioJet RT because of intracoronary thrombus per physician discretion (RT group, n = 32). A group of 32 control patients were identified by matching patients based on infarct related artery (IRA) location and initial thrombolysis in MI (TIMI) flow grade (control group, n = 32). Interventional procedures and definitions. Cardiogenic shock was defined as systolic blood pressure
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