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Primary percutaneous intervention for acute occlusion of a native coronary artery may be complicated by distal embolization of plaque or thrombotic debris, with infarct extension. We tested the clinical application of a new therapeutic strategy combining maximal antiplatelet therapy, with glycoprotein IIb/IIIa inhibition, and adjunctive mechanical protection from distal embolization and direct aspiration of thrombus with a new balloon and catheter system (PercuSurgetrade mark). Successful aspiration of thrombus could be obtained in 7 out of 8 attempted procedures, with inability to negotiate the angulated take-off of the circumflex coronary artery in one patient. The current mechanical characteristics of the device, primarily developed for use in larger saphenous vein grafts, and certain caveats and limitations are discussed. 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 branches and no intraprocedural complications.

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The action of nifedipine (N), acebutolol (A), and their association (A+N) was studied in 16 patients suffering from effort angina with documented coronary artery disease. The therapeutic action was valued by bicycle effort stress test after oral administration of medications in comparison with placebo (P), following a double-blind random sequence of treatments. Working capacity significantly increased after A (507 ± 450 mkp, p < 0.05), after N (1,140 ± 767 mkp, p < 0.001), and after A+N (1,198 ± 644 mkp, p < 0.01). The increments of work after P administration were not significant. Moreover, fatigue instead of angina appeared as a stopping criterion in 8 patients after A+N, and in only 1 patient after P, A, and N.