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[OCC2010]PCI过程中的冠脉血栓清除术: 临床依据和当今技术
The Coronary Thrombectomy during PCI: Clinical Evidence & Current Technology
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 关键字:PCI 冠脉血栓清除术 

     Reperfusion therapy in acute myocardial infarction (AMI) aims at reducing mortality and morbidity by achieving patency of the epicardial infarct-related artery and by restoring myocardial tissue perfusion.The presence of coronary thrombus during primary percutaneous coronary intervention (PCI) is a therapeutic challenge. Coronary thrombus in acute coronary syndromes has been associated with an increase of major adverse cardiac events, which have relationship with lower postprocedure thrombolysis in MI myocardial perfusion grade, distal embolization, "no-reflow" phenomenon, and drug-eluting stent thrombosis.
 
     Dr. Jiangtao Yu introduced current status about coronary thrombectomy during PCI. A meta-analysis from De Luca G et al demonstrated that among patients with AMI treated with PCI, the use of adjunctive manual thrombectomy devices was associated with better epicardial and myocardial perfusion, less distal embolization and significant reduction in 30-day mortality. But in Bayesian meta-analysis, adjunctive thrombectomy improved early markers of reperfusion but didn’t substantially effect 30-day post-MI mortality, reinfarction, and stroke. The use of aspiration thrombectomy devices was not associated with a reduction in post-MI clinical outcomes. Thrombectomy was one of the rare effective preventive measures against no-reflow.
 
     In particular in patients with significant thrombus burden, the efficiency of a simple manual thrombectomy catheter is not sufficient in many cases.The ThromCat™ thrombectomy catheter system was a single-use, disposable device intended for the removal of thrombus. It contains infusion helix and extraction helix. The infusion helix pumps NaCl into the catheter. The extraction helix builds up a vacuum of 700 mm Hg by rotating the helix with 95,000 rpm. The vacuum sucks the thrombus into the extraction holes of the catheter and macerates it. Due to the high rate of success in removing coronary thrombus and improved myocardial perfusion, the Thromcat systems is a new alternative for treating lesions with thrombus burden.

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