A new strategy of reperfusion therapy in acute myocardial infarction: Usefulness of a simple and effective thrombus aspiration therapy using a Rescue^™ percutaneous thrombectomy system

Background: Although coronary angioplasty is effective in the treatment of acute myocardial infarction (AMI), distal coronary embolization originating from an intracoronary thrombus may attenuate the beneficial impact of reperfusion therapy. Coronary thrombectomy prior to angioplasty may reduce the embolic complications. Methods and Results: We evaluated the angiographic outcomes of 66 patients with AMI who underwent thrombus aspiration with a Rescue^™ percutaneous thrombectomy system (Rescue) followed by adjunctive angioplasty. The Rescue catheter was able to pass the culprit lesion in 60 of the studied patients (91%). Visible thrombi were obtained in 57 patients (86%). On average, the aspirated thrombi weighed 10.4+/-14.7 mg. Histological examination revealed three types of thrombi (white, red and mixed thrombi). Although the following angioplasty was associated with the reduction of the distal embolization in 20 patients (33%), the intracoronary injection of vasodilators and the recurrent thrombus aspiration improved coronary flow in 10 patients. Final TIMI 3 flow was achieved in 47 patients (78%). Conclusions: Thrombus aspiration with Rescue can be a simple and effective reperfusion therapy, allowing for an initial strategy prior to angioplasty in the treatment of AMI. Furthermore, histological evaluation reveals the cellular components of the aspirated thrombus, which may enhance the better understanding of the pathophysiology of AMI.