Transradial application of percusurge guardwire device during primary percutaneous intervention of infarct‐related artery with high‐burden thrombus formation

Abstract

A large infarct-related artery (IRA), which mostly contains high-burden thrombus formation (HBTF) and lipid pool-like plaque contents, has been suggested to play a pivotal role in the no-reflow phenomenon during primary percutaneous coronary intervention (p-PCI). To reduce the thrombus burden of the IRA using the PercuSurge GuardWire device before intervention may be of crucial importance to preventing no-reflow. The purposes of this study were to test the transradial application (TRA) of this new mechanical device and to determine its impact on prevention of no-reflow during p-PCI. From May to September 2002, the PercuSurge GuardWire device was utilized in 42 consecutive patients with acute myocardial infarction and large IRA (vessel size >or= 3.5 mm with HBTF; group 1). From January to December 2000, p-PCI was performed in large IRA (vessel size >or= 3.5 mm) with HBTF using tranfemoral arterial approach in 101 consecutive patients (group 2). The angiographic and clinical outcomes of the two groups were compared in a chronologically consecutive manner. Successful reperfusion (final TIMI-3 flow) was significantly higher in group 1 than in group 2 patients (95.2% vs. 79.1%; P = 0.005). Moreover, the combined incidence of vascular complications, post-PCI thromboembolisms (defined as a distal embolism and a post-PCI residual thrombus score of >or= 3), and combined 30-day major adverse cardiac events were significantly lower in group 1 than in group 2 patients (all P values < 0.05). In group 1 patients, post-p-PCI myocardial blush (MB) of >or= 2 grades was found to be more than 88.0%. Furthermore, when compared with preintervention, thrombus scores were significantly reduced after aspiration (P = 0.0001), whereas the minimal lumen diameter (P = 0.0001), TIMI flow grade (P = 0.0001), and MB grade (P = 0.0001) had all significantly increased after aspiration using Export Aspiration Catheter. There were no significant differences in corrected TIMI frame count (P = 0.42), TIMI flow grade (P > 0.5), or MB grade (all P values > 0.5) between postaspiration and post-PCI. The TRA of the PercuSurge GuardWire device during primary intervention of large IRA with HBTF was safe and feasible and provided benefits to patients. The initial successful reduction of the thrombus burden with this mechanical device before intervention can be translated into increased final TIMI-3 flow, a combined MB of >or= 2 grades, and fewer final thromboembolic events.

Distal Protection Improved Reperfusion and Reduced Left Ventricular Dysfunction in Patients With Acute Myocardial Infarction Who Had Angioscopically Defined Ruptured Plaque

“…According to previous reports 36,37 that revealed the distal protection device to be effective in acute MI, distal embolism of thrombus was suggested as a major cause of microcirculation damage. However, the pathological examination of the aspirated samples in the present study revealed that samples from the patients with ruptured plaque contained more plaque debris than those without ruptured plaque.…”

Six-month angiographic results of primary angioplasty with adjunctive PercuSurge GuardWire device support: Evaluation of the restenotic rate of the target lesion and the fate of the distal balloon occlusion site

“…The procedures and protocol were described previously [11]. Briefly, a transradial artery approach using 6 Fr arterial sheath is the design protocol for AMI in our hospital unless Allen's test is positive.…”

“…Recently, we reported preliminary data on utilization of the PercuSurge device during primary PCI [11]. Most of our patients have now received a 6-month angiographic follow-up.…”

“…Recently, utilization of mechanical devices [7][8][9][10][11] has emerged as an attractive therapeutic strategy for patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI), because the combined use of these mechanical devices and primary PCI provides a higher rate of successful reperfusion than does conventional primary PCI alone. Of these mechanical devices, the PercuSurge device has been utilized relatively more frequently in the clinical setting of AMI [7,8,11]. However, data regarding utilization of the PercuSurge device during primary PCI are still limited.…”

“…Clinical and experimental studies have demonstrated that artificial barotrauma to the endothelium and media of the coronary artery with balloon inflation can cause later coronary artery stenosis [3][4][5][6]. Recently, utilization of mechanical devices [7][8][9][10][11] has emerged as an attractive therapeutic strategy for patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI), because the combined use of these mechanical devices and primary PCI provides a higher rate of successful reperfusion than does conventional primary PCI alone. Of these mechanical devices, the PercuSurge device has been utilized relatively more frequently in the clinical setting of AMI [7,8,11].…”