Effectiveness of rheolytic coronary thrombectomy with the AngioJet catheter

Abstract

Thrombus-filled lesions are associated with a higher rate of acute complications and long-term restenosis following conventional coronary or saphenous vein graft (SVG) intervention. To evaluate the clinical effectiveness of rheolytic thrombectomy in a nonselected population in the glycoprotein IIb/IIIa blockade era, we reviewed clinical, angiographic, and procedural data on 119 patients who underwent 126 consecutive coronary AngioJet procedures (29% in SVGs, and 71% in native coronary arteries) from July 1998 to August 2000. Glycoprotein IIb/IIIa blockers were used in 88%. Most vessels (68% of SVGs, 74% of native coronary arteries) were occluded initially. Complete or substantial removal of filling defects was achieved in 76% of SVGs and 66% of native coronary cases. The AngioJet rheolytic thrombectomy device led to significant improvement in lumen diameter and Thrombolysis In Myocardial Infarction (TIMI) flow, with reduction in the thrombotic lesion length (p <0.05). Angiographic success (<30% residual stenosis, TIMI-3) was attained in 73% of SVGs and 87% of native coronary procedures. Distal embolization occurred in 13 cases, and was less likely to occur in patients treated with abciximab (0%) compared with patients treated with other glycoprotein IIb/IIIa blockers or heparin alone (17%, p = 0.02). A favorable response to the AngioJet (odds ratio 3.9) and freedom from embolization (odds ratio 14.6) were associated with a higher procedural success rate. In-hospital and long-term clinical outcomes were favorable. Thus, rheolytic thrombectomy resulted in significant reduction of the thrombus burden in most patients, restored TIMI-3 flow, and led to favorable short- and long-term outcomes.