Skip to main content
SpringerLink
Log in

Rheolytic Thrombectomy Does Not Prevent Slow-, No-Reflow During Percutaneous Coronary Intervention in Acute Myocardial Infarction

  • Original Article
  • Published:
International Journal of Angiology

Abstract

Percutaneous coronary intervention (PCI) in acute myocardial infarction (MI) has been associated with a high incidence of slow-, no-reflow. The slow-, no-reflow phenomenon is known to complicate both thrombolytic therapy and PCI. Removing intracoronary thrombus before PCI in acute MI patients may reduce the incidence of slow-, no-reflow phenomena. We studied the procedural outcome of 21 patients who underwent rheolytic thrombectomy using Possis® rheolytic thrombectomy catheter in the setting of acute MI as compared to twenty-eight patients who underwent PCI in the setting of acute MI using other modalities (PTCA with or without stenting) without thrombectomy. The study included 49 consecutive patients with 21 patients in the rheolytic thrombectomy group, and 28 patients in the no-rheolytic thrombectomy group. There was no significant difference between the two groups as regards to gender, age, and prevalence of coronary artery risk factors. The left ventricular ejection fraction was 44.7 ± 12 in the rheolytic thrombectomy group, and 37.6 ± 10.8 in the no-rheolytic thrombectomy group (p = 0.08). Thirty eight percent of the patients in the rheolytic thrombectomy group experienced slow flow, no-reflow, while 28.6% of the patients in the no-rheolytic thrombectomy group experienced slow flow, no-reflow (p = 0.5). In this matched series of patients with acute MI undergoing PCI, rheolytic thrombectomy by the Possis rheolytic thrombectomy catheter device does not appear to reduce the risk of slow flow, no-reflow, or in-hospital death, compared to standard PTCA and stenting of the infarct-related artery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. JL Anderson L Karagounis LC Becker SG Sorensen RL Menlove (1993) ArticleTitleTIMI perfusion grade 3 but not grade 2 results in improved outcome after thrombolysis for myocardial infarction: Ventriculographic, enzymatic, and electrocardiographic evidence from the TEAM-3 study. Circulation 87 1829–1839 Occurrence Handle1:STN:280:DyaK3s3nvVyjtw%3D%3D Occurrence Handle8504495 Occurrence Handle10.1161/01.CIR.87.6.1829

    Article  CAS  PubMed  Google Scholar 

  2. R Erbel G Heusch (2000) ArticleTitleCoronary microembolization. J Am Coll Cardiol 36 IssueID1 22–24 Occurrence Handle1:STN:280:DC%2BD3czlsVOksA%3D%3D Occurrence Handle10898407 Occurrence Handle10.1016/S0735-1097(00)00708-7

    Article  CAS  PubMed  Google Scholar 

  3. S Feld M Ganim ES Carell O Kjellgren RL Kirkeeide WK Vaughn R Kelly AI McGhie N Kramer D Loyd HV Anderson G Schroth RW Smalling (1996) ArticleTitleComparison of angioscopy, intravascular ultrasound imaging and quantitative coronary angiography in predicting clinical outcome after coronary intervention in high risk patients. J Am Coll Cardiol 28 IssueID1 97–105 Occurrence Handle1:STN:280:DyaK283os1Sqtg%3D%3D Occurrence Handle8752800 Occurrence Handle10.1016/0735-1097(96)00102-7

    Article  CAS  PubMed  Google Scholar 

  4. CL Grines DA Cox GW Stone E Garcia LA Mattos A Giambartolomei BR Brodie O Madonna M Eijgelshoven AJ Lansky WW O’Neill MC Morice (1999) ArticleTitleCoronary angioplasty with or without stent implantation for acute myocardial infarction. N Eng J Med 341 26 1949–1956 Occurrence Handle10.1056/NEJM199912233412601

    Article  Google Scholar 

  5. H Ito A Maruyama K Iwakura S Takiuchi T Masuyama M Hori Y Higashino K Fujisi T Minamino (1996) ArticleTitleClinical implications of the ‘no reflow’ phenomenon: a predictor of complications and left ventricular remodeling in reperfused anterior wall myocardial infarction. Circulation 93 223–228 Occurrence Handle1:STN:280:DyaK287jsVeqtQ%3D%3D Occurrence Handle8548892 Occurrence Handle10.1161/01.CIR.93.2.223

    Article  CAS  PubMed  Google Scholar 

  6. H Ito A Okamura K Iwakura T Masuyama M Hori S Takiuchi S Negoro Y Nakatsuchi Y Taniyama Y Higashino K Fujisi T Minamino (1996) ArticleTitleMyocardial perfusion patterns related to thrombolysis in myocardial infarction grades after coronary angioplasty in patients with acute anterior wall myocardial infarction. Circulation 93 1993–1999 Occurrence Handle1:STN:280:DyaK283ktVCltA%3D%3D Occurrence Handle8640973 Occurrence Handle10.1161/01.CIR.93.11.1993

    Article  CAS  PubMed  Google Scholar 

  7. H Ito T Tomooka N Sakai H Yu Y Higashino K Fujsii T Masuyama A Kitabatake T Minamino (1992) ArticleTitleLack of myocardial perfusion immediately after successful thrombolysis: a predictor of poor recovery of left ventricular function in anterior myocardial infarction. Circulation 85 1699–1705 Occurrence Handle1:STN:280:DyaK383ktVOmsQ%3D%3D Occurrence Handle1572028 Occurrence Handle10.1161/01.CIR.85.5.1699

    Article  CAS  PubMed  Google Scholar 

  8. BM Kaplan T Larkin RD Safian WW O’Neill B Kramer M Hoffmann T Schreiber CL Grines (1996) ArticleTitleProspective study of extraction atherectomy in patients with acute myocardial infarction. Am J Cardiol 15 78 IssueID4 383–388 Occurrence Handle1:STN:280:DyaK28zlvFCiuw%3D%3D Occurrence Handle10.1016/S0002-9149(96)00323-2

    Article  CAS  Google Scholar 

  9. NS Kleiman HD White EM Ohman (1994) ArticleTitleMortality within 24 hours of thrombolysis for myocardial infarction. The importance of early reperfusion. Circulation 90 2658–2665 Occurrence Handle1:STN:280:DyaK2M%2FoslWjtA%3D%3D Occurrence Handle7994805 Occurrence Handle10.1161/01.CIR.90.6.2658

    Article  CAS  PubMed  Google Scholar 

  10. RA Kloner (1989) ArticleTitleNo re-flow revisited. J Am Coll Cardiol 14 1814–1815 Occurrence Handle1:STN:280:DyaK3c%2Fmt1yjtA%3D%3D Occurrence Handle2584573 Occurrence Handle10.1016/0735-1097(89)90037-5

    Article  CAS  PubMed  Google Scholar 

  11. RA Kloner CE Ganote RB Jennings (1974) ArticleTitleThe “no-reflow” phenomenon after temporary coronary occlusion in the dog. J Clin Inv 54 1496–1508 Occurrence Handle1:STN:280:DyaE2M%2FmtVKrsA%3D%3D Occurrence Handle10.1172/JCI107898

    Article  CAS  Google Scholar 

  12. M Kondo A Nakano D Saito Y Shimono (1998) ArticleTitleAssessment of “microvascular no-reflow phenomenon” using technetium-99m micro-aggregated albumin scintigraphy in patients with acute myocardial infarction. J Am Coll Cardiol 32 898–903 Occurrence Handle1:STN:280:DyaK1cvjvFKntw%3D%3D Occurrence Handle9768709 Occurrence Handle10.1016/S0735-1097(98)00435-5

    Article  CAS  PubMed  Google Scholar 

  13. JA Leopold CJ Berger LA Cupples (2000) ArticleTitleNo-reflow during coronary intervention: observations and implications. Circulation 102 II–644

    Google Scholar 

  14. M Marzilli E Gliozheni P Marraccini S Fedele (1998) ArticleTitlePrimary coronary angioplasty in acute myocardial infarction: clinical correlates of the ‘no reflow’ phenomenon. Int J Cardiol 65 IssueIDSuppl 1 S23–28 Occurrence Handle9706823 Occurrence Handle10.1016/S0167-5273(98)00060-6

    Article  PubMed  Google Scholar 

  15. I Morishima T Sone S Mokuno S Taga A Shimauchi Y Oki J Kondo H Tsuboi H Sassa (1995) ArticleTitleClinical significance of no-reflow phenomenon observed on angiography after successful treatment of acute myocardial infarction with percutaneous transluminal coronary angioplasty. Am Heart J 130 239–243 Occurrence Handle1:STN:280:DyaK2MzlvVWitA%3D%3D Occurrence Handle7631601 Occurrence Handle10.1016/0002-8703(95)90434-4

    Article  CAS  PubMed  Google Scholar 

  16. RD Safian (2001) No-Reflow. RD Safian MS Freed (Eds) The Manual of Interventional Cardiology, 3rd edition. Michigan; Physcians’ Press Royal Oak 413–421

    Google Scholar 

  17. SK Sharma G Dangas R Mehran S Duvvuri A Kini TP Cocke V Kakarala AM Cohen JD Marmur JA Ambrose (1997) ArticleTitleRisk factors for the development of slow flow during rotational coronary atherectomy. Am J Cardiol 15 80 IssueID2 219–222 Occurrence Handle1:STN:280:DyaK2szntlKrtg%3D%3D Occurrence Handle10.1016/S0002-9149(97)00325-1

    Article  CAS  Google Scholar 

  18. JA Silva CJ White TJ Collins SR Ramee (1998) ArticleTitleMorphologic comparison of atherosclerotic lesions in native coronary arteries and saphenous vein graphs with intracoronary angioscopy in patients with unstable angina. Am Heart J 136 IssueID1 156–163 Occurrence Handle1:STN:280:DyaK1czivVWksg%3D%3D Occurrence Handle9665233 Occurrence Handle10.1016/S0002-8703(98)70196-6

    Article  CAS  PubMed  Google Scholar 

  19. RJ Simes EJ Topol DR Holmes Jr (1995) ArticleTitleLink between the angiographic sub-study and mortality outcomes in a large randomized trial of myocardial reperfusion. Importance of early and complete infarct artery reperfusion. Circulation 91 1923–1928 Occurrence Handle1:STN:280:DyaK2M3gt1yisw%3D%3D Occurrence Handle7895348 Occurrence Handle10.1161/01.CIR.91.7.1923

    Article  CAS  PubMed  Google Scholar 

  20. E Vallejo MA Pena-Duque O Norono E Ban Hayashi J Gaspar R Villavicencio MA Martinez Rios (1998) ArticleTitleThe no-reflow phenomenon: its incidence and clinical characteristics in a series of cases (Spanish). Arch Inst Cardiol Mex 68 247–252 Occurrence Handle1:STN:280:DyaK1M%2FivVSnsA%3D%3D Occurrence Handle9810347

    CAS  PubMed  Google Scholar 

  21. BK Whisenant DS Baim RE Kuntz LA Garcia SR Ramee JP Carrozza (1999) ArticleTitleRheolytic thrombectomy with the Possis rheolytic thrombectomy: Technical Considerations and Initial Clinical Experience. J Invasive Cardiol 11 IssueID7 421–426 Occurrence Handle1:STN:280:DC%2BD2M7msVSlsg%3D%3D Occurrence Handle10745565

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Division of Cardiology, University of Texas Medical School and Hermann Hospital, Houston, Texas, USA

    Hany Awadalla M.B.B.S., M.Sc., Joseph Salloum M.D., Ali Moustapha M.D.,, Abid Assali M.D., Stefano Sdringola M.D., Kenichi Fujise M.D., Vernon H. Anderson M.D., Oscar Rosales M.D., George Schroth M.D. & Richard W. Smalling M.D. Ph.D.

Authors
  1. Hany Awadalla M.B.B.S., M.Sc.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joseph Salloum M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ali Moustapha M.D.,
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abid Assali M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stefano Sdringola M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kenichi Fujise M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vernon H. Anderson M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Oscar Rosales M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. George Schroth M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Richard W. Smalling M.D. Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Richard W. Smalling M.D. Ph.D..

About this article

Cite this article

Awadalla, H., Salloum, J., Moustapha, A. et al. Rheolytic Thrombectomy Does Not Prevent Slow-, No-Reflow During Percutaneous Coronary Intervention in Acute Myocardial Infarction . International Journal of Angiology 12, 183–187 (2003). https://doi.org/10.1007/s00547-003-1005-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00547-003-1005-3

Keywords

Search

Navigation