Routine Use of the “Penumbra” Thrombectomy Device in Myocardial Infarction: A Real-World Experience—ROPUST Study

Abstract

Objectives. Evaluation of the safety and efficacy of the Penumbra device as an adjunct to percutaneous coronary intervention (PCI) in patients with myocardial infarction (MI) and a large thrombus burden that requires thrombectomy. Background. For patients with acute MI, PCI is the primary reperfusion method. Large thrombus burden has always been a limitation of successful reperfusion. However, the use of current aspiration devices has been associated with an increased incidence of stroke. Methods. We performed a retrospective chart review at the University Hospitals Medical Center in Cleveland. Our study included data from patients who underwent PCI for ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI) assisted by the Penumbra Cat RX device (a wide-lumen thrombus aspiration catheter) between May 2019 and February 2021. The primary outcome was the final thrombolysis in myocardial infarction (TIMI) flow. The secondary endpoints were a composite of adverse cardiac events at 6 months. About 50% of the patients did undergo transfemoral PCI as per preference of individual operators. The Penumbra thrombectomy device can be used both by radial and femoral approach and does not need any different guide catheter use. Results. TIMI flow 3 was achieved in 111 patients (90.2%). The secondary endpoint occurred in 11 patients (8.9%, 3 MI, 8 heart failure hospitalizations). There were no stroke events or device-related complications. The door-to-balloon time was not affected by usage of the Penumbra device. Failure in the restoration of TIMI 3 flow was associated with the use of balloon angioplasty prior to the application of the Penumbra device, leading to distal embolization. Conclusions. The Penumbra Cat RX provides safe and effective thrombus removal with better clinical outcomes, even in high-risk patients with acute coronary syndrome.

Use of the Indigo CAT RX aspiration system during percutaneous coronary intervention

“…Final TIMI flow 3 was restored in 111 of 123 (90.2%) patients. 16 Neither of these studies reported device-related serious adverse Our study complements the findings of the aforementioned studies showing high success and low incidence of complications.…”

Clot Management in Primary Percutaneous Coronary Intervention: Fighting Your Enemy

“…The rheolytic thrombectomy group did not show benefit in the primary endpoint of infarct size and surrogate endpoints of angiographic parameters of perfusion, while a benefit was shown in MACE at 6 months and 1 year. 28 With the available data, major guidelines do not recommend routine use of rheolytic thrombectomy. 18,19 The Indigo Aspiration System (Penumbra) is another option for mechanical thrombectomy that has been used in coronary thrombosis in recent years, although clinical data are still limited.…”

Thrombus Aspiration in Acute Myocardial Infarction: A Long-Awaited Resurgence?

“…Newer studies offer hope for a possible resurgence of thromboaspiration with the availability of better tools, and most importantly optimized adjuvant intracoronary and/or intravenous antithrombotic, antiplatelet, vasodilatory and myocardium-preserving therapies. 6,[11][12][13][14][15] For now, it seems that patients with a high coronary thrombus burden may be those most likely to benefit from selective thromboaspiration, always aided by adjuvant pharmacotherapies. 6,11,16 ORCID iD Antonis S. Manolis  https://orcid.org/0000-0002-0336-4745…”

“…6,[11][12][13][14][15] For now, it seems that patients with a high coronary thrombus burden may be those most likely to benefit from selective thromboaspiration, always aided by adjuvant pharmacotherapies. 6,11,16 ORCID iD Antonis S. Manolis  https://orcid.org/0000-0002-0336-4745…”

“…A recent retrospective study (Routine Use of the “Penumbra” Thrombectomy Device in Myocardial Infarction: A Real-World Experience—ROPUST Study) comprising 123 patients who underwent PCI for STEMI and non-STEMI assisted by the new Penumbra CAT RX device (a wide-lumen thrombus aspiration catheter) reported that TIMI coronary flow 3 was achieved in 111 patients (90.2%). 11 The secondary endpoint of MACE (a composite of death, recurrent MI, and heart failure hospitalization) occurred in 11 patients (8.9%, 3 MI, 8 heart failure hospitalizations). There were no stroke events or device-related complications.…”