045 Coronary thrombectomy: technical comparison of two systems on a laboratory bench. Impact of bends, angles and thrombus age

Abstract

Despite the results of recent randomized studies, the systematic use of aspiration techniques in ST-elevation myocardial infarction has not been included in the new guidelines. To date, there have been very few bench tests of the different systems and the aim of our study was to test two catheters on different models of arteries with 6 and 12-hour-old thrombi. The test apparatus consisted of 3-mm diameter glass tubes of 150 mm in length. The thrombi were left for either 6 or 12 hours and ten models of tubes were used: straight, with a single bend and with two bends. Two types of catheter were tested: the Export® aspiration catheter (EAC) and the Proxis® embolic protection system (PES). The main assessment criterion was total thrombectomy. Total thrombectomy was achieved in only 55.3% of the tests and no difference appeared between the two systems. Total thrombectomy was achieved more frequently with 6-h thrombi than with 12-h thrombi for the two techniques, 62.5% vs. 42.5% (p = 0.018) and 67.5% vs. 48.7% (p = 0.025) for EAC and PES catheter, respectively. In contrast, total thrombectomy was more frequent in straight tubes and in tubes with a single bend than in tubes with double bends, respectively for EAC (64% vs. 44.8%, p = 0.028) and for PES (85.9% vs. 35.4%, p<0.001). The use of thrombectomy in the invasive management of acute coronary syndromes is growing. Our work on a “laboratory bench” reveals important technical differences. In consequence, in clinical practice, we speculate that the catheter system must be chosen according to both the artery anatomy and the delay between chest pain and PCI.