1
|
Chan SM, Laage Gaupp FM, Mojibian H. ClotTriever system for mechanical thrombectomy of deep vein thrombosis. Future Cardiol 2023; 19:29-38. [PMID: 36637020 DOI: 10.2217/fca-2022-0100] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
There is increasing evidence that early and comprehensive removal of thrombus in deep vein thrombosis is associated with improved outcomes, including decreased incidence of post-thrombotic syndrome and debilitating long-term symptoms. Catheter-directed thrombolysis is effective for the rapid removal of clot, but it is associated with high bleeding risk. Percutaneous mechanical thrombectomy is a highly effective method for the removal of clot without the use of systemic or catheter-directed thrombolytic therapy. The Inari ClotTriever system (Inari Medical Inc., CA, USA) is a thrombectomy device, which is approved for deep vein thrombosis by the US FDA in 2017. Herein we review the current treatment strategies using the ClotTriever system, its specifications, indications and current state of literature.
Collapse
Affiliation(s)
- Shin Mei Chan
- Yale University School of Medicine, New Haven, CT 06510, USA
| | - Fabian M Laage Gaupp
- Department of Radiology & Biomedical Imaging, Section of Vascular & Interventional Radiology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Hamid Mojibian
- Department of Radiology & Biomedical Imaging, Section of Vascular & Interventional Radiology, Yale University School of Medicine, New Haven, CT 06510, USA
| |
Collapse
|
2
|
Jenab Y, Rezaee M, Hosseini K, Ghaderian H, Haddad RN, Zaidi AN. Percutaneous stent implantation for occluded central shunts in adults: A case report and review of current evidence. Front Cardiovasc Med 2022; 9:1032974. [PMID: 36479575 PMCID: PMC9720738 DOI: 10.3389/fcvm.2022.1032974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/25/2022] [Indexed: 11/22/2022] Open
Abstract
Background Patients with cyanotic complex congenital heart defects (CHDs) commonly undergo palliation with interposition of systemic-to-pulmonary shunts (SPSs). These palliative shunts are rarely found in adults with CHDs and can be complicated with progressive obstruction or total occlusion during follow-up. The best treatment option for shunt re-permeabilization is challenging and case-oriented because most patients are high risk candidates for redo surgeries. We aimed to review the current evidence on percutaneous stent implantation to treat failed SPSs. Methods We performed a comprehensive literature review on percutaneous stent implantation to treat failed and occluded SPSs. We also reported the case of a 33-year-old man with cyanotic CHD and a occluded central aorto-pulmonary shunt, who was successfully treated with percutaneous balloon dilatation and subsequently stent implantation at our institution. Result We identified and included 31 articles reporting on 150 patients and 165 stent implantations in failed SPSs. The age of patients at the time of stent implantation ranged from 6 days to 47 years. The time between the surgical shunt creation and transcatheter intervention ranged from 1 day to 17 years. Overall, 161/165 (97.5%) stent implantations were successful. The most common clinical presentation was cyanosis and decreased atrial oxygen saturations and the indication for stent implantation was shunt obstruction and stenosis. Conclusion This review highlights the benefits of endovascular stenting to permeabilize failed SPSs in children and adults with complex CHD who are classified as poor candidates for re-surgical repair.
Collapse
Affiliation(s)
- Yaser Jenab
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Malihe Rezaee
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran,School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Homa Ghaderian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran,*Correspondence: Homa Ghaderian,
| | - Raymond N. Haddad
- M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Ali N. Zaidi
- Mount Sinai Adult Congenital Heart Disease Center, Icahn School of Medicine, New York, NY, United States
| |
Collapse
|
3
|
Rai R, Jalkote S, Shaikh S, Gupta A, Bansal N. BailOut angioplasty in a case of thrombus migration. JOURNAL OF CLINICAL AND PREVENTIVE CARDIOLOGY 2021. [DOI: 10.4103/jcpc.jcpc_1_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
4
|
Alexopoulos D, Davlouros PA. Thrombus extraction catheters vs. angiojet rheolytic thrombectomy in thrombotic lesions/SV grafts. Curr Cardiol Rev 2013; 8:202-8. [PMID: 22920486 PMCID: PMC3465825 DOI: 10.2174/157340312803217265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 03/07/2012] [Accepted: 03/14/2012] [Indexed: 11/22/2022] Open
Abstract
Primary percutaneous coronary intervention, (pPCI), of native coronaries and saphenous vein grafts (SVGs), is the recommended reperfusion strategy for STEMI, and an early invasive approach is recommended for high risk patients with UA/NSTEMI. Although PCI effectively restores flow in the infarct related artery/culprit vessel in both situations, myocardial perfusion often remains suboptimal due to microvascular obstruction, partly attributed to distal embolization of thrombus. Hence, thrombectomy (manual or mechanical), prior to stenting may further reduce hard clinical end points in patients with ACS. This article discusses accumulated evidence regarding the safety and effectiveness of thrombectomy in culprit native coronaries and SVGs in such patients, as well as possible strategies for maximizing its benefits relative to the size of the thrombotic burden.
Collapse
|
5
|
Feinstein JA, Benson DW, Dubin AM, Cohen MS, Maxey DM, Mahle WT, Pahl E, Villafañe J, Bhatt AB, Peng LF, Johnson BA, Marsden AL, Daniels CJ, Rudd NA, Caldarone CA, Mussatto KA, Morales DL, Ivy DD, Gaynor JW, Tweddell JS, Deal BJ, Furck AK, Rosenthal GL, Ohye RG, Ghanayem NS, Cheatham JP, Tworetzky W, Martin GR. Hypoplastic left heart syndrome: current considerations and expectations. J Am Coll Cardiol 2012; 59:S1-42. [PMID: 22192720 PMCID: PMC6110391 DOI: 10.1016/j.jacc.2011.09.022] [Citation(s) in RCA: 347] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 09/06/2011] [Accepted: 09/20/2011] [Indexed: 01/25/2023]
Abstract
In the recent era, no congenital heart defect has undergone a more dramatic change in diagnostic approach, management, and outcomes than hypoplastic left heart syndrome (HLHS). During this time, survival to the age of 5 years (including Fontan) has ranged from 50% to 69%, but current expectations are that 70% of newborns born today with HLHS may reach adulthood. Although the 3-stage treatment approach to HLHS is now well founded, there is significant variation among centers. In this white paper, we present the current state of the art in our understanding and treatment of HLHS during the stages of care: 1) pre-Stage I: fetal and neonatal assessment and management; 2) Stage I: perioperative care, interstage monitoring, and management strategies; 3) Stage II: surgeries; 4) Stage III: Fontan surgery; and 5) long-term follow-up. Issues surrounding the genetics of HLHS, developmental outcomes, and quality of life are addressed in addition to the many other considerations for caring for this group of complex patients.
Collapse
Affiliation(s)
- Jeffrey A Feinstein
- Department of Pediatrics, Stanford University School of Medicine, Lucile Salter Packard Children's Hospital, Palo Alto, California 94304, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Use of the AngioJet system in the treatment of acute STEMI. COR ET VASA 2009. [DOI: 10.33678/cor.2009.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
7
|
Gillespie MJ, Rome JJ. Transcatheter treatment for systemic-to-pulmonary artery shunt obstruction in infants and children. Catheter Cardiovasc Interv 2008; 71:928-35. [DOI: 10.1002/ccd.21448] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
8
|
Kirsch J, Rasmussen PA, Masaryk TJ, Perl J, Fiorella D. ADJUNCTIVE RHEOLYTIC THROMBECTOMY FOR CENTRAL VENOUS SINUS THROMBOSIS. Neurosurgery 2007; 60:E577-8; discussioin E578. [PMID: 17327769 DOI: 10.1227/01.neu.0000255339.26027.68] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Patients with dural sinus thrombosis occasionally present with a malignant clinical course marked by parenchymal hemorrhage accompanied by either a severe neurological deficit or a persistent deterioration on therapeutic levels of antithrombotic medications. This scenario precludes traditional revascularization strategies with direct fibrinolytic infusion because of the risk of exacerbating the preexisting cerebral hemorrhage. In the current series, we describe our experience using the AngioJet (Possis Medical, Minneapolis, MN), a rheolytic mechanical thrombectomy device, in conjunction with systemic heparinization to achieve rapid sinus revascularization without fibrinolytic therapy.
METHODS
A retrospective review of a prospectively maintained database identified four patients ranging in age from 28 to 67 years (three women, one man) with cerebral venous thrombosis and rapidly deteriorating levels of consciousness who underwent transfemoral intravenous rheolytic thrombectomy using the AngioJet XMI and/or Xpeedior catheters (Possis Medical). The imaging features, treatment specifications, and disease outcome were reviewed.
RESULTS
All four patients underwent successful mechanical thrombectomy as indicated by restoration of blood flow through the affected sinuses. Three of the four patients demonstrated normalization of angiographic transit time after thrombectomy. In these three patients, rapid neurological improvement ensued. The fourth patient died during the periprocedural period. No procedural complications were encountered.
CONCLUSION
Systemic heparinization with adjunctive rheolytic thrombectomy (without fibrinolytic therapy) is a safe and effective treatment strategy for selected patients with dural venous sinus thrombosis.
Collapse
Affiliation(s)
- Jacobo Kirsch
- Department of Neuroradiology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
| | | | | | | | | |
Collapse
|
9
|
Barbato JE, Wholey MH. Use of AngioJet mechanical thrombectomy for acute peripheral ischemia associated with stent fracture. Catheter Cardiovasc Interv 2007; 70:795-8. [DOI: 10.1002/ccd.21245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
10
|
Burzotta F, Trani C, Romagnoli E, Belloni F, Biondi-Zoccai GGL, Mazzari MA, De Vita M, Giannico F, Garramone B, Niccoli G, Rebuzzi AG, Mongiardo R, Schiavoni G, Crea F. A pilot study with a new, rapid-exchange, thrombus-aspirating device in patients with thrombus-containing lesions: the Diver C.E. study. Catheter Cardiovasc Interv 2006; 67:887-93. [PMID: 16683272 DOI: 10.1002/ccd.20713] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND In patients with acute coronary syndromes (ACS), distal embolization of thrombotic material is more likely to play a key role in the pathogenesis of myocardial no-reflow during percutaneous coronary intervention (PCI). Thus, interventional techniques able to reduce thrombus burden at the culprit vessel might improve final myocardial reperfusion. OBJECTIVE To evaluate a new rapid-exchange thrombus-aspirating catheter, the Diver C.E., in patients with thrombotic coronary lesions undergoing PCI. METHODS Fifty patients with acute myocardial infarction (n = 44) or with non-ST-elevation ACS and angiographic evidence of coronary thrombus (n = 6) undergoing urgent PCI were prospectively enrolled. The Diver C.E. was used to aspirate coronary thrombus from the culprit lesion after placement of the guidewire. Adjunctive balloon inflations and stent implantation were used to achieve good angiographic result. Angiographic coronary flow (by means of TIMI score and corrected TIMI frame count, cTFC), thrombus score (TS), and myocardial perfusion (by means of postintervention myocardial blush grade, MBG) were assessed in all patients. RESULTS The device could be successfully employed in 96% of the cases (48/50) and yielded significant (P < 0.0001) acute reduction in thrombus burden (TS: predevice 3.5 +/- 0.8, postdevice 2.5 +/- 0.9) and improvement in coronary flow (TIMI grade: predevice 1.0 +/- 0.9, postdevice 2.0 +/- 0.9; CTFC predevice 71 +/- 31, postdevice 39 +/- 26). Final TIMI grade 0-1 was observed in one patient only (2%). A significant (P = 0.02) correlation was found between preintervention TS and efficacy of thrombus aspiration. A more pronounced acute reduction of thrombus burden after thrombus aspiration (TS reduction > or = 2) was associated with a better postintervention angiographic myocardial perfusion (MBG 2.3 +/- 0.9 vs 1.7 +/- 0.8; P = 0.05). CONCLUSIONS This new, easy-to-use, device is able to reduce thrombus burden and to improve coronary flow in patients with thrombus-containing lesions. The improvement in myocardial perfusion associated to greater thrombus removal highlights the importance of thrombus aspiration in the management of thrombus-burdened coronary lesions.
Collapse
|
11
|
Matar F, Gloer K, Barrett C, Sires O, Thakore S, Warner J, Thompson Sullebarger J, Ebra G. Synergism of rheolytic thrombectomy and embolic distal protection using the percusurge guard wire for fresh thrombus removal: an in vitro study. ACTA ACUST UNITED AC 2006; 8:31-4. [PMID: 16720425 DOI: 10.1080/14628840600623757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To test the effectiveness of Rheolytic Thrombectomy (RT) and distal protection balloon wires when used synergistically in an in vitro model. BACKGROUND Although effective, currently available technologies may not be individually ideal for fresh clots removal. METHODS Fourteen, fresh blood samples were placed in 14 plastic tubes and left to clot for 6 h. A Percusurge Guardwire balloon was inflated distal to the clot and aspiration was performed using RT in seven tubes and manual aspiration (MA) with the Export catheter in seven tubes. The residual clot in each tube was dried and weighed. Both aspiration systems were advanced over the Guardwire. RESULTS During RT, none of the protection balloons ruptured and no retrograde clot embolization were observed. MA was most effective when the Export catheter tip was not in direct contact with the clot. The residual clot mass post RT was significantly less than post MA (9.7+/-2.2 versus 59.2+/-45.9, P = 0.01). CONCLUSION RT is compatible with Distal Protection Balloon Wires and results in more complete clot removal than manual aspiration with the export catheter. Although manual aspiration results in a large variation in extraction efficacy, it is most effective when direct catheter-clot contact is kept to a minimum.
Collapse
Affiliation(s)
- Fadi Matar
- The Cardioquest Research Laboratories, Tampa, Florida 33609, USA.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Ali A, Cox D, Dib N, Brodie B, Berman D, Gupta N, Browne K, Iwaoka R, Azrin M, Stapleton D, Setum C, Popma J. Rheolytic thrombectomy with percutaneous coronary intervention for infarct size reduction in acute myocardial infarction: 30-day results from a multicenter randomized study. J Am Coll Cardiol 2006; 48:244-52. [PMID: 16843170 DOI: 10.1016/j.jacc.2006.03.044] [Citation(s) in RCA: 227] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2005] [Revised: 02/28/2006] [Accepted: 03/02/2006] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The goal of this work was to determine whether rheolytic thrombectomy (RT) as an adjunct to primary percutaneous coronary intervention (PCI) reduces infarction size and improves myocardial perfusion during treatment of ST-segment elevation myocardial infarction (STEMI). BACKGROUND Primary PCI for STEMI achieves brisk epicardial flow in most patients, but myocardial perfusion often remains suboptimal. Distal embolization of thrombus during treatment may be a contributing factor. METHODS This prospective, multicenter trial enrolled 480 patients presenting within 12 h of symptom onset and randomized to treatment with RT as an adjunct to PCI (n = 240) or to PCI alone (n = 240). Visible thrombus was not required. The primary end point was infarct size measured by sestamibi imaging at 14 to 28 days. Secondary end points included final Thrombolysis In Myocardial Infarction (TIMI) flow grade, tissue myocardial perfusion (TMP) blush, ST-segment resolution, and major adverse cardiac events (MACE), defined as the occurrence of death, new Q-wave myocardial infarction, emergent coronary artery bypass grafting, target lesion revascularization, stroke, or stent thrombosis at 30 days. RESULTS Final infarct size was higher in the adjunct RT group compared with PCI alone (9.8 +/- 10.9% vs. 12.5 +/- 12.13%; p = 0.03). Final TIMI flow grade 3 was lower in the adjunct RT group (91.8% vs. 97.0% in the PCI alone group; p < 0.02), although fewer patients had baseline TIMI flow grade 3 in the adjunct RT group (44% vs. 63% in the PCI alone group; p < 0.05). There were no significant differences in TMP blush scores or ST-segment resolution. Thirty-day MACE was higher in the adjunct RT group (6.7% vs. 1.7% in the PCI alone group; p = 0.01), a difference primarily driven by very low mortality rate in patients treated with PCI alone (0.8% vs. 4.6% in patients treated with adjunct RT; p = 0.02). CONCLUSIONS Despite effective thrombus removal, RT with primary PCI did not reduce infarct size or improve TIMI flow grade, TMP blush, ST-segment resolution, or 30-day MACE.
Collapse
Affiliation(s)
- Arshad Ali
- Robert Packer Hospital, Sayre, Pennsylvania, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Morrison DA, Thai H, Goldman S, Felix E, Hernandez J. Percutaneous coronary intervention of or through saphenous vein grafts or internal mammary arteries: the impact of stents, adjunctive pharmacology, and multicomponent distal protection. Catheter Cardiovasc Interv 2006; 67:571-9. [PMID: 16547927 DOI: 10.1002/ccd.20641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We hypothesized that the use of stents and aggressive adjunctive pharmacotherapies has been associated with lower rates of complicating myocardial infarction (MI) and improved long-term outcomes compared to either previous balloon-only percutaneous coronary intervention (PCI) or atheroablative intervention for lesions of or through saphenous vein grafts (SVGs) and/or internal mammary arteries (IMAs). PCI of SVG has been complicated by relatively high rates of procedural MI and less favorable long-term outcomes than native vessel PCI, stimulating the development and application of an array of technologies. This study was based on retrospective review of stent-era (1999-2004) 5-year experience of a single center with 95 SVG procedures in 85 patients and 20 IMA procedures in 20 patients. These cases were compared with the previously published experience of one of the operators during the balloon-only period and literature review of the application of multiple technologies to SVG intervention, as well as consideration of the reoperation alternative. There was one in-hospital death each in the SVG cohort (1%) and in the IMA cohort (5%). There were SIX procedural MIs (6%), defined by total CK > normal, and 19 procedural MIs (20%) based on troponin-I > 1.0. Follow-up has been from 4 months to 5 years (average, 2.5 years), with 91% survival and one late CABG in the IMA group. SVG PCI with stents and adjunctive pharmacotherapies is associated with relatively low rates of procedural MI and favorable long-term outcomes.
Collapse
Affiliation(s)
- Douglass A Morrison
- Section of Cardiology, Department of Internal Medicine, SAVAHCS, and the University of Arizona, Sarver Heart Center, Tucson, 85723, USA.
| | | | | | | | | |
Collapse
|
14
|
Movahed MR. Persistent and proximal migration of a large coronary thrombus during percutaneous coronary intervention in the setting of acute Q-wave myocardial infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2006; 7:48-50. [PMID: 16513524 DOI: 10.1016/j.carrev.2005.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Accepted: 08/31/2005] [Indexed: 11/27/2022]
Abstract
We describe a patient with an acute inferior myocardial infarction. Patient was taken to the cardiac catheterization laboratory for primary angioplasty. Angiography revealed 100% occluded proximal right coronary artery (RCA). After initial balloon angioplasty of the occluded RCA, a very large mobile thrombus was seen in the proximal RCA. Despite multiple stenting, suctioning through the guide catheter lumen, and intracoronary thrombolytic therapy, the thrombus persisted and migrated proximally after each stenting. However, patient did well despite of persistent large thrombus burden in the proximal RCA on aggressive antithrombotic treatment.
Collapse
Affiliation(s)
- Mohammad-Reza Movahed
- Division of Cardiology, Department of Medicine, University of California, Irvine Medical Center, Orange, CA 92868-4080, USA.
| |
Collapse
|
15
|
Ziakas A, Gavrilidis S, Makris P, Louridas G. Acute left main occlusion during percutaneous coronary intervention associated with heparin induced thrombocytopenia with thrombosis syndrome. J Interv Cardiol 2005; 18:139-44. [PMID: 15882162 DOI: 10.1111/j.1540-8183.2005.04070.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A 76-year-old male was admitted with Braunwald IIIB unstable angina and treated with intravenous heparin. Coronary angiography 20 days later revealed a severe stenosis in the left circumflex artery. During coronary angioplasty thrombus developed in the circumflex artery, extended in the left main and lead to its occlusion. Normal left coronary artery patency and flow were achieved after intracoronary and intravenous administration of abciximab, and multiple stenting. Platelet-count decrease and an ELISA assay documented the presence of heparin-induced thrombocytopenia with thrombosis syndrome (HITTS). HITTS should be suspected after acute thrombus formation during coronary angioplasty.
Collapse
Affiliation(s)
- Antonios Ziakas
- 1st Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
| | | | | | | |
Collapse
|
16
|
Topaz O, Perin EC, Jesse RL, Mohanty PK, Carr M, Rosenschein U. Power thrombectomy in acute ischemic coronary syndromes. Angiology 2003; 54:457-68. [PMID: 12934766 DOI: 10.1177/000331970305400410] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intracoronary thrombi are commonly found in patients with acute coronary syndromes. A large thrombus burden or a platelet-rich thrombus frequently resists pharmacologic therapy ("thrombolytic ceiling"). In such cases restoration of adequate antegrade coronary flow necessitates application of a mechanical force. Power thrombectomy is a revascularization strategy incorporating a mechanical device for removal of occlusive coronary thrombi in conjunction with or following administration of either platelet glycoprotein IIb/IIIa receptor inhibitors or thrombolytic agents, or both. Mechanical devices for power thrombectomy include ultrasound sonication, rheolytic thrombectomy (Angiojet), laser, transluminal extraction catheter, aspiration catheter, and to a limited extent, balloon angioplasty. In acute coronary syndromes the strategy of power thrombectomy aims to achieve the clinical advantages of more nearly complete vessel patency, improved antegrade flow, and enhanced preservation of myocardial tissue.
Collapse
Affiliation(s)
- On Topaz
- Cardiac Catheterization Laboratories, Division of Cardiology, Medical College of Virginia Hospital, Medical College of Virginia/Virginia Commonwealth University, Richmond, VA 23249, USA
| | | | | | | | | | | |
Collapse
|
17
|
|
18
|
Feng L, Mangla S, Pile-Spellman J. Rheolytic Thrombectomy of Acute Stent Thrombosis of Cervical Vertebral Artery. Interv Neuroradiol 2002; 8:305-12. [DOI: 10.1177/159101990200800311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2002] [Accepted: 08/17/2008] [Indexed: 11/16/2022] Open
Abstract
A new Xpeedior rheolytic thrombectomy catheter has been successfully used to extract thrombus from an acutely thrombosed vertebral artery stent without apparent distal embolism. The ease of use and the speed of thrombectomy suggest that this system may be useful for the treatment of acute ischemic stroke.
Collapse
Affiliation(s)
- L. Feng
- Division of Interventional Neuroradiology, Departments of Radiology, New York Presbyterian Hospital, Columbia University; U.S.A
| | - S. Mangla
- Division of Interventional Neuroradiology, Departments of Radiology, New York Presbyterian Hospital, Columbia University; U.S.A
- Division of Interventional Neuroradiology, Department of Neurosurgery and Neurology, New York Presbyterian Hospital, Columbia University; U.S.A
| | - J. Pile-Spellman
- Division of Interventional Neuroradiology, Departments of Radiology, New York Presbyterian Hospital, Columbia University; U.S.A
- Division of Interventional Neuroradiology, Department of Neurosurgery and Neurology, New York Presbyterian Hospital, Columbia University; U.S.A
| |
Collapse
|
19
|
|