Intracoronary administration of abciximab via an intracoronary perfusion catheter in patients with a thrombotic coronary occlusion—a single center experience

Abstract

Aims: At concentrations superior to those achieved with the standard intravenous dose for coronary procedures, abciximab has an active dethrombotic effect by displacing platelet-bound fibrinogen. This analysis investigates whether administration of abciximab by local intracoronary infusion through the ClearWay (CX) RX perfusion catheter improves coronary blood flow (TIMI flow) by reducing thrombus burden. Methods and Results: This retrospective study included 68 patients who presented with an acute coronary syndrome due to an intracoronary thrombus between May 2009 and April 2011. The primary endpoint was defined as improvement in Thrombolysis In Myocardial Infarction (TIMI) flow after intracoronary application of abciximab via the ClearWay (CW) RX perfusion catheter. The population (mean age 58±11 years) consisted of 54 patients (79%) with an ST-elevation myocardial infarction and 14 patients (21%) with a non-ST-elevation myocardial infarction. The balloon-diameter of the perfusion catheter was 1 mm in 25 (37%), 1.5 mm in 23 (34%), 2.0 mm in 14 (20%), and 3.0 mm in 6 patients (9%), respectively. Successful positioning of the balloon within the thrombus was not possible in 4 patients (6%). After infusion of abciximab using the perfusion catheter TIMI flow improved by one grade in 17 patients (25%), by two grades in 9 patients (13%), and by three grades in 7 patients (10%), TIMI flow remained unchanged in 21 patients (31%), and even worsened by one grade in 4 patient (6%) (χ test, Pb.001). The procedure was complicated by an air embolization in 5 patients (7%). Air embolization occurred using a 2 mm balloon (three patients) or a 3 mm balloon (two patients), but not using a 1 mm or 1.5 mm balloon (χ, Pb.003). After the use of the perfusion catheter in these patients TIMI flow improved by one degree in 2 of these patients, was unchanged in 2 of these patients and worsened by one grade in one patient. After additional treatment with thrombectomy (54 patients, 79%), initial balloon dilatation (46 patients, 68%), direct stenting (22 patients, 32%), and stent implantation (64 patients, 94%), the final TIMI flow was TIMI 3 in 57 patients (84%), TIMI 2 in 4 patients (6%), TIMI 1 in 6 patients (9%), and TIMI 0 in 1 patient (1%). Conclusion: The intracoronary infusion of abciximab using the ClearWay (CX) RX perfusion catheter helps to improve myocardial perfusion in patients with acute coronary syndrome due to an intracoronary thrombus. The use of perfusion catheters with a balloon ≥2 mm can be associated with air embolism.