M.R. Adams*, G.J. Blake, D.I. Simon, C.D. Rogers, A.P. Selwyn, J.J. Popma.

The Department of Cardiology, Brigham and Women's Hospital, Boston MA, U.S.A.

Thrombotic lesions in native coronary arteries and saphenous vein grafts (SVG) are associated with poor outcomes in percutaneous interventional procedures. The Possis Angiojet catheter removes intracoronary thrombus by rheolytic thrombectomy. A Venturi effect is created at the tip of the catheter by high-pressure jets of saline, and the resulting vacuum remove thrombus through the central lumen.

We report preliminary experience with rheolytic thrombectomy over a 12-month period at our institution. Twenty-one thrombotic lesions in 21 patients were treated with the Possis Angiojet catheter. Eleven patients presented with acute myocardial infarction (AMI) and 3 were in cardiogenic shock at presentation. Sixteen lesions were within native coronary arteries and 5 were within SVGs. The device was successfully delivered to 20 of 21 lesions (95%) and flow improved by visual estimate in 19 of 21 (90%). Subsequent treatment included angioplasty and stenting in 14 patients and balloon angioplasty in 6. One patient did not require adjunctive angioplasty or stenting. Nineteen patients (90%) were treated with glycoprotein IIb/IIIa receptor blockade. Four patients required intra-aortic balloon pump support. Complications of rheolytic thrombectomy included distal embolisation (2 of 21, 9.5%), transient reversible bradycardia (3 of 21, 14%), no reflow (2 of 21, 9.5%), and ventricular tachycardia requiring cardioversion (3 of 21, 14%). Acute procedural success was achieved in 20 of 21 patients (95%).

Rheolytic thrombectomy with the Possis Angiojet catheter offers a novel approach for treating the challenging problem of intracoronary thrombus. Initial experience indicates a high success rate for thrombus removal in both native coronaries and SVGs.

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