Intracoronary thrombectomy improves myocardial reperfusion in patients undergoing direct angioplasty for acute myocardial infarction
Massimo Napodano, MD*,
Giampaolo Pasquetto, MD*,
Salvatore Saccà, MD*,
Carlo Cernetti, MD*,
Virginia Scarabeo, MD*,
Pietro Pascotto, MD* and
Bernhard Reimers, MD*,*
* Department of Cardiology, Mirano, Italy
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Figure 1 Angiographic images of thrombectomy procedure. (A) Occluded proximal left descending artery (arrow). (B) Intraluminal thrombus (arrow) evidenced after crossing the lesion with a wire. (C) Result after thrombectomy. (D) Final result after direct stent deployment.
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Figure 2 Thrombolysis In Myocardial Infarction (TIMI) flow grade (A) and myocardial blush grade (MBG) (B) after each step of the procedure. There were no differences between groups in TIMI flow at baseline, after wiring, and at the end of procedure (A). The MBG was similar between groups at baseline and after wire crossing. At the end of procedure, the MBG was significantly higher (p = 0.006; chi-square) in patients undergoing thrombectomy (B).
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Figure 3 Changes in mean myocardial blush grade (MBG) observed during the procedure. In patients undergoing thrombectomy, the MBG was enhanced after aspiration (p = 0.002; analysis of variance [ANOVA]), and it did not show further significant improvement (p = 0.20; ANOVA) after optimizing treatment by balloon angioplasty and/or stenting. In patients undergoing conventional approach, MBG significantly improved after intervention (p = 0.01; ANOVA). At the end of the procedure, MBG was higher in patients undergoing thrombectomy (p = 0.001; ANOVA). Solid squares = thrombectomy; solid triangles = no thrombectomy.
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Figure 4 Thrombolysis In Myocardial Infarction (TIMI) flow grade (A) and myocardial blush grade (MBG) (B) at baseline and after the procedure according to the use or not of glycoprotein IIb/IIIa inhibitors. There were no statistically significant differences between groups in TIMI flow and in MBG (p= NS; chi-square).
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