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Masuda R, Shibui T, Mizunuma Y, Yoshikawa S, Takeda K, Kujiraoka H, Yamaoka K, Arai T, Inagaki D, Kimura T, Yoshida K, Takahashi M, Kitamura T, Hojo R, Tsuchiyama T, Fukamizu S, Sasano T. Impact of small diameter and low level of emission laser coronary atherectomy in patients with acute myocardial infarction. Lasers Med Sci 2021; 37:1567-1573. [PMID: 34436695 PMCID: PMC8971151 DOI: 10.1007/s10103-021-03405-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/18/2021] [Indexed: 11/26/2022]
Abstract
Excimer laser coronary atherectomy (ELCA) is an effective treatment to remove intracoronary thrombi. In the present study, we compared in-hospital mortality in patients with acute myocardial infarction (AMI) who underwent conventional treatment and conventional treatment plus ELCA. Among 656 patients who were admitted to our hospital through the Tokyo CCU Network, 104 patients with AMI who were treated by percutaneous coronary intervention between January 2013 and December 2016 met inclusions criteria and underwent conventional treatment with ELCA (ELCA group) and 89 underwent conventional treatment alone (conventional group). We retrospectively evaluated in-hospital mortality within 30 days and used propensity score (PS) matching to reduce assignment bias and multivariate analysis to detect the predictors of in-hospital mortality. In-hospital mortality rate was significantly lower in the ELCA group before and after PS matching (2.9% vs. 13.5%, p = 0.006 before PS matching, and 2.8% vs. 14.1%, p = 0.016 after PS matching). After PS matching, β-blocker or statins use, incidence of shock, Killip classification, and door-to-balloon time were not significantly different. A multivariate logistic regression analysis identified ELCA, dyslipidemia, shock, and left ventricular ejection fraction as independent predictors of in-hospital mortality (odds ratio (OR), 0.147, 95% confidence interval [CI], 0.022–0.959, p = 0.045; OR, 0.077, 95% CI, 0.007–0.805, p = 0.032; OR, 6.494, 95% CI, 1.228–34.34, p = 0.028; OR, 0.890, 95% CI, 0.828–0.957, p = 0.002, respectively). Our data indicate that ELCA with the small diameter and low level emission may reduce the in-hospital mortality compared to conventional methods in patients with AMI in drug-eluting stent era.
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Affiliation(s)
- Ryo Masuda
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan.
| | - Takashi Shibui
- Department of Cardiology, Toshima Hospital in the Tokyo Metropolitan Health and Hospitals Corporation, 33-1, Sakaecho, Itabashi, Tokyo, 173-0015, Japan
| | - Yoshiaki Mizunuma
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Shogo Yoshikawa
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Kosuke Takeda
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Hirofumi Kujiraoka
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Koichiro Yamaoka
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Tomoyuki Arai
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Dai Inagaki
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Takashi Kimura
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Kiyotaka Yoshida
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Masao Takahashi
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Takeshi Kitamura
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Rintaro Hojo
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Takaaki Tsuchiyama
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Seiji Fukamizu
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Tetsuo Sasano
- Department of Cardiology, Tokyo Medical and Dental University Hospital, 5-45, Yushima 1-Chome, Bunkyo, Tokyo, 113-8519, Japan
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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.
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Affiliation(s)
- Jacobo Kirsch
- Department of Neuroradiology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Topaz O, Ebersole D, Das T, Alderman EL, Madyoon H, Vora K, Baker JD, Hilton D, Dahm JB. Excimer laser angioplasty in acute myocardial infarction (the CARMEL multicenter trial). Am J Cardiol 2004; 93:694-701. [PMID: 15019871 DOI: 10.1016/j.amjcard.2003.11.050] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2003] [Revised: 11/21/2003] [Accepted: 11/21/2003] [Indexed: 12/20/2022]
Abstract
Patients with acute myocardial infarction (AMI) with thrombus-laden lesions constitute a revascularization challenge. Thrombus and atherosclerotic plaque absorb laser energy; thus, we studied the safety and efficacy of excimer laser in AMI. In a multicenter trial, 151 patients with AMI underwent excimer laser angioplasty. Baseline left ventricular ejection fraction was 44 +/- 13%, and 13% of patients were in cardiogenic shock. A saphenous vein graft was the target vessel in 21%. Quantitative coronary angiography and statistical analysis were performed by independent core laboratories. A 95% device success, 97% angiographic success, and 91% overall procedural success rate were recorded. Maximal laser gain was achieved in lesions with extensive thrombus burden (p <0.03 vs small burden). Thrombolysis In Myocardial Infarction (TIMI) trial flow increased significantly by laser: 1.2 +/- 1.1 to 2.8 +/- 0.5 (p <0.001), reaching a final 3.0 +/- 0.2 (p <0.001 vs baseline). Minimal luminal diameter increased by laser from 0.5 +/- 0.5 to 1.6 +/- 0.5 mm (mean +/- SD, p <0.001), followed by 2.7 +/- 0.6 mm after stenting (p <0.001 vs baseline and vs after laser). Laser decreased target stenosis from 83 +/- 17% to 52 +/- 15% (mean +/- SD, p <0.001 vs baseline), followed by 20 +/- 16% after stenting (p <0.001 vs baseline and vs after laser). Six patients (4%) died, each presented with cardiogenic shock. Complications included perforation (0.6%), dissection (5% major, 3% minor), acute closure (0.6%), distal embolization (2%), and bleeding (3%). In a multivariant regression model, absence of cardiogenic shock was a significant factor affecting procedural success. Thus, in the setting of AMI, gaining maximal thrombus dissolution in lesions with extensive thrombus burden, combined with a considerable increase in minimal luminal diameter and restoration of anterograde TIMI flow, support successful debulking by excimer laser. The presence of thrombus does not adversely affect procedural success; however, cardiogenic shock remains a predictor of major adverse events during hospitalization.
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Affiliation(s)
- On Topaz
- Medical College of Virginia Hospitals, VCU, Richmond, Virginia 23249, USA.
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