X-Sizer for Thrombectomy in Acute Myocardial Infarction Improves ST-Segment Resolution

Lefèvre, Thierry; García, E. Gargallo; Reimers, Bernhard; Lang, Irene M.; Mario, Carlo Di; Colombo, Antonio; Neumann, Franz‐Joseph; Chávarri, Mariano Valdés; Brunel, Philippe; Grube, E; Thomas, Martin; Glatt, B.; Ludwig, Joseph A.; Investigators, Xience

doi:10.1016/j.jacc.2005.04.031

Cited by 165 publications

(9 citation statements)

References 42 publications

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“…In this regard, the use of a mechanical device for thrombus removal or trapping to improve clinical outcomes after p-PCI is attractive, and the efficacy of these devices has been tested in many clinical trials. Although some data, especially those regarding the use of distal protection devices, have failed to show clinical benefits due in part to patient and device selection [48][49][50][51][52][53] , many recent large-scale randomized trials have demonstrated significant improvements in myocardial perfusion 45,[54][55][56][57][58][59][60][61][62][63][64][65][66][67] and the left ventricular function 64,65) in addition to reduced mortality 68) ( 69) . In addition, Burzotta et 70) .…”

Section: Thrombus Aspiration/distal Protection Therapy and Its Efficacymentioning

confidence: 99%

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Thrombus Aspiration Therapy and Coronary Thrombus Components in Patients with Acute ST-Elevation Myocardial Infarction

Yunoki

Naruko

Sugioka

et al. 2013

JAT

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Inflammation and oxidative stress play key roles in atherosclerotic plaque instability, and plaque rupture/erosion and subsequent thrombus formation constitute the principal mechanisms of total vessel occlusion and acute ST-elevation myocardial infarction (STEMI). Plaque disruption triggers the formation of initial platelet aggregates that grow in association with an increase in fibrin formation, leading to persistent coronary flow obstruction and blood coagulation. The fibrin network may trap large numbers of erythrocytes and inflammatory cells to form an erythrocyte-rich thrombus. In fact, previous clinical studies have shown that not only platelet-rich white thrombi, but also erythrocyte-rich red thrombi can be visualized using angioscopy in patients with acute coronary syndrome. Recently, the development of thrombus aspiration and distal protection devices has significantly improved the clinical outcomes of percutaneous intervention in STEMI patients and has enabled the evaluation of antemortem coronary artery thrombi. This is important because previous autopsy studies were unable to differentiate coronary thrombi responsible for myocardial ischemia from postmortem clots. Using frozen samples of aspirated thrombi and specific monoclonal antibodies, we investigated the cellular components of thrombi (platelets, erythrocytes, fibrin and inflammatory cells, such as myeloperoxidase-positive cells) and pathologically evaluated the relationships between erythrocyterich thrombi and inflammation, oxidative stress and clinical outcomes in STEMI patients. Therefore, this review article focuses on the efficacy of thrombus aspiration therapy and the components of aspirated intracoronary thrombi in STEMI patients and presents the results of recent studies regarding the relationship between the composition of aspirated intracoronary thrombi and clinical outcomes.

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Section: Thrombus Aspiration/distal Protection Therapy and Its Efficacymentioning

confidence: 99%

“…Burzotta et al 58) (REMEDIA trial) Lefévre et al 59) (X AMINE ST trial) Silva-Orrego et al 60) (DEAR-MI study) Chevalier et al 61) (Export study) Sardella et al 62) (EXPIRA trial) Dudek et al 63) (PIHRATE trial) De Luca et al…”

Section: )unclassified

Thrombus Aspiration Therapy and Coronary Thrombus Components in Patients with Acute ST-Elevation Myocardial Infarction

Yunoki

Naruko

Sugioka

et al. 2013

JAT

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“…In the Randomized Evaluation of the Effect of Mechanical Reduction of Distal Embolization by Thrombus-Aspiration in Primary and Rescue Angioplasty (REMEDIA) trial, use of the manual aspiration Diver catheter (Invatec S.r.l., Brescia, Italy) before stent implantation was associated with improved ST-segment resolution and myocardial perfusion (19). Similarly, in the X-SIZER in Acute Myocardial Infarction Patients for Negligible Embolization and Optimal ST Resolution (X AMINE ST) trial, adjunctive thrombectomy with the X-Sizer device (eV3, Plymouth, Minnesota) led to better ST-segment resolution (20). In contrast, Kaltoft (21) found that patients who were treated with the Boston Scientific Rescue device (Mountain View, California) had significantly larger final infarct size at 30 days compared with patients treated with PCI alone.…”

Section: Acute Myocardial Infarction (Ami)mentioning

confidence: 97%

The Year in Interventional Cardiology

Dixon

Grines

O’Neill

2006

Journal of the American College of Cardiology

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“…X-Sizer has two lumina: the outermost is connected to a vacuum bottle for debris aspiration (along with blood, collected into an in-line filter), while the innermost is for conventional guidewire passage. Helical thrombectomy is usually performed as a pre-stenting procedure, in order to reduce thrombus burden and improve the outcome of the procedure (Lefèvre et al 2005). Cutting and aspiration are designed to keep the risk of distal embolization low; however, complications like distal embolization, perforation and incomplete recanalization are reported in literature (C. H. Lee et al 2007).…”

Section: Helical Atherectomy/thrombectomymentioning

confidence: 99%

Removing vascular obstructions: a challenge, yet an opportunity for interventional microdevices

Miloro

Sinibaldi

Menciassi

et al. 2012

Biomed Microdevices

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Cardiovascular diseases are the leading cause of death worldwide; they are mainly due to vascular obstructions which, in turn, are mainly caused by thrombi and atherosclerotic plaques. Although a variety of removal strategies has been developed for the considered obstructions, none of them is free from limitations and conclusive. The present paper analyzes the physical mechanisms underlying state-of-art removal strategies and classifies them into chemical, mechanical, laser and hybrid (namely chemo-mechanical and mechano-chemical) approaches, while also reviewing corresponding commercial/research tools/devices and procedures. Furthermore, challenges and opportunities for interventional micro/nanodevices are highlighted. In this spirit, the present review should support engineers, researchers active in the micro/nanotechnology field, as well as medical doctors in the development of innovative biomedical solutions for treating vascular obstructions. Data were collected by using the ISI Web of Knowledge portal, buyer's guides and FDA databases; devices not reported on scientific publications, as well as commercial devices no more for sale were discarded. Nearly 70% of the references were published since 2006, 55% since 2008; these percentages respectively raise to 85% and 65% as regards the section specifically reviewing state-of-art removal tools/devices and procedures.

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X-Sizer for Thrombectomy in Acute Myocardial Infarction Improves ST-Segment Resolution

Abstract: Reducing thrombus burden with X-Sizer before stenting leads to better myocardial reperfusion, as illustrated by a reduced risk of distal embolization and better ST-segment resolution.

Cited by 165 publications

References 42 publications

Thrombus Aspiration Therapy and Coronary Thrombus Components in Patients with Acute ST-Elevation Myocardial Infarction

Thrombus Aspiration Therapy and Coronary Thrombus Components in Patients with Acute ST-Elevation Myocardial Infarction

The Year in Interventional Cardiology

Removing vascular obstructions: a challenge, yet an opportunity for interventional microdevices

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