Rheolytic thrombectomy does not prevent slow-, no-reflow during percutaneous coronary intervention in acute myocardial infarction

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.