RESUMO
Percutaneous intervention in the setting of aortocoronary saphenous vein graft disease is associated with a significant risk of distal embolization. Devices intended to minimize the clinical impact of embolization have primarily utilized distally placed occlusive balloons or filters. Although such systems are often effective, distal protection does have limitations. We report a novel proximal embolic protection and rinsing system intended to overcome some of these limitations.
Assuntos
Angioplastia Coronária com Balão/instrumentação , Implante de Prótese Vascular/instrumentação , Oclusão de Enxerto Vascular/prevenção & controle , Veia Safena/transplante , Angiografia Coronária , Desenho de Equipamento , Oclusão de Enxerto Vascular/diagnóstico por imagem , Humanos , Período Intraoperatório , Isquemia Miocárdica/terapia , Stents , Sucção/instrumentaçãoRESUMO
Angiographic thrombus is associated with poorer procedural and clinical outcomes. We report our experience with the X-Sizer thrombectomy device (EndiCOR Medical) from March 2001 to December 2002. Indications for use in 44 patients (33 male; mean age, 60) included myocardial infarction (27), unstable angina (6), periprocedural thrombosis (2), acute (< 24 hr) stent thrombosis (1), and subacute (> 24 hr) stent thrombosis (8). Three cases involved vein grafts. Deployment was successful in 42/44. Difficulty traversing the stent occurred in 5/9 cases of in-stent thrombosis. Median TIMI flow increased from 1 to 2 (P = 0.01) postthrombectomy. Median final TIMI flow was 3. Complications included dissection (1), perforation, device jam on stent (1), disruption of a covered stent (1), distal macro-embolization (4), and transient no-reflow (5). The X-Sizer thrombectomy device improves TIMI flow but does not always prevent distal embolization. Care is needed when treating in-stent thrombosis.
