A trial comparing rheolytic thrombectomy with intracoronary urokinase for coronary and vein graft thrombus (the Vein Graft AngioJet Study [VeGAS 2

Abstract

Percutaneous coronary or vein graft interventions in thrombus-containing lesions carry high risks for complications including abrupt closure, late reocclusion, periprocedural myocardial infarction, emergent coronary bypass surgery, and death. 1 White C.J Ramee S.R Collins T.J Escobar A.E Karsan A Shaw D Jain S.P Bass T.A Heuser R.R Teirstein P.S et al. Coronary thrombi increase PTCA risk. Angioscopy as a clinical tool. Circulation. 1996; 93: 253-258 Crossref PubMed Scopus (188) Google Scholar , 2 Waxman S Sassower M.A Mittleman M.A Zarich S Miyamoto A Manzo K.S Muller J.E Abela G.S Nesto R.W Angioscopic predictors of early adverse outcome after coronary angioplasty in patients with unstable angina and non-Q wave myocardial infarction. Circulation. 1996; 93: 2106-2113 Crossref PubMed Scopus (74) Google Scholar Various strategies for thrombus removal have emerged including pharmacologic thrombolysis, 3 Hartmann J.R McKeever L.S O’Neill W.W White C.J Whitlow P.L Gilmore P.S Doorey A.J Galichia J.P Enger E.L Recanalization of Chronically Occluded Aortocoronary Saphenous Vein Bypass Grafts with Long-Term, Low Dose Direct Infusion of Urokinase (ROBUST) a serial trial. J Am Coll Cardiol. 1996; 27: 60-66 Abstract Full Text PDF PubMed Scopus (58) Google Scholar mechanical compression by balloon angioplasty, mechanical removal using extraction and atherectomy devices, 4 Dooris M Hoffmann M Glazier S Juran N Reddy V Grines C.L Pavlides G.S Schreiber T O’Neill W.W Safian R.D Comparative results of transluminal extraction coronary atherectomy in saphenous vein graft lesions with and without thrombus. J Am Coll Cardiol. 1995; 25: 1700-1705 Abstract Full Text PDF PubMed Scopus (45) Google Scholar , 5 Lefkovits J Holmes D.R Califf R.M Safian R.D Pieper K Keeler G Topol E.J Predictors and sequelae of distal embolization during saphenous vein graft intervention from the CAVEAT-II trial. Coronary Angioplasty Versus Excisional Atherectomy Trial. Circulation. 1995; 92: 734-740 Crossref PubMed Scopus (113) Google Scholar ultrasonic thrombolysis, 6 Rosenschein U Roth A Rassin T Basan S Laniado S Miller H.I Analysis of coronary ultrasound thrombolysis endpoints in acute myocardial infarction (ACUTE Trial). Results of the feasibility study. Circulation. 1997; 95: 1411-1416 Crossref PubMed Scopus (121) Google Scholar and dissolution using glycoprotein IIb/IIIa inhibitors. 7 Muhlestein J.B Karagounis L.A Treehan S Anderson J.L “Rescue” utilization of abciximab for the dissolution of coronary thrombus developing as a complication of coronary angioplasty. J Am Coll Cardiol. 1997; 30: 1729-1734 Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar These strategies, however, have limitations related to efficacy, complication rates, prolonged hospital stay, or patient discomfort. Rheolytic thrombectomy (AngioJet, Possis Medical, Inc., Minneapolis, Minnesota) is a catheter-based system that uses high-velocity water jets to produce a vacuum for thrombus aspiration and extraction, as described previously 8 Whisenant B.K Baim D.S Kuntz R.E Garcia L.A Ramee S.R Carrozza J.P Rheolytic thrombectomy with the Possis AngioJet technical considerations and initial clinical experience. J Invasive Cardiol. 1999; 11: 421-426 PubMed Google Scholar (Figure 1). The Vein Graft AngioJet Study (VeGAS 1) demonstrated safety and feasibility for AngioJet thrombectomy in native coronary arteries and saphenous vein grafts (SVGs). 9 Ramee S.R Schatz R.A Carrozza P Leon M.B Ho K.K Baim D.S Lanoue A.S Senerchia C Kuntz R.E Results of the VeGAS 1 pilot study of the Possis coronary AngioJet thrombectomy catheter. Circulation. 1996; 94 (abstr): 3622 Google Scholar The randomized VeGAS 2 trial was designed to evaluate the clinical efficacy of rheolytic thrombectomy compared with intracoronary urokinase for the treatment of thrombus-containing lesions in SVGs or native coronary arteries.