By Naveen Rajpurohit
Aspiration thrombectomy in acute myocardial infarction has been an area of controversy. Manual aspiration thrombectomy has a “Class IIa indication” in STEMI per ACC/AHA STEMI guidelines.(1) Meta-analysis by Dr. Kumbhani, from the University of Texas Southwestern Medical Center in Dallas, and colleagues had shown that aspiration thrombectomy devices improved myocardial reperfusion parameters and mortality.(2) Another recent trial (TASTE) showed that aspiration thrombectomy did not confer any mortality benefit.(3) This has led to an interest in finding better aspiration catheters.
We describe a case series of patients with acute myocardial infarction where GuideLiner catheter (GL) was used for aspiration thrombectomy.(4) We used 6 Fr GL with same guide size for manual aspiration thrombectomy. In our series, the GL proved superior to the Export catheter regarding the amount and completeness of thrombus retrieval. Our GL technique was easy to apply.
The internal diameter and cross-sectional area of a 6 Fr GL are significantly greater than that of the Export catheter. The internal diameter of a 6 Fr GL catheter is 0.056˝ (1.42 mm), which corresponds to a cross-sectional area of 1.48 mm2 (after subtracting the area of guidewire). The internal diameter of Export catheter is 0.041˝ (1.016 mm), which corresponds to a cross-sectional area of only 0.81 mm2. Thus, the cross-sectional area of the GL is almost double that of the Export catheter. The Pronto V3 aspiration catheter is larger than Export, but its cross-sectional area (0.93 mm2) is still smaller than that of the GL. The dedicated aspiration catheters have tips modified for improvement of flow characteristics and safety; however, the GL round atraumatic tip can symmetrically aspirate thrombus and adapt to the vessel. It has been demonstrated that the main factor for thrombus aspiration is internal diameter of the aspiration catheter and actually straight tip catheter works better than beveled tip. Our GL technique resulted in complete angiographic thrombus disappearance and normal flow restoration in all cases.
We propose the GL catheter as an alternative to dedicated coronary aspiration devices for thrombus removal in acute MI, especially in large vessels and in proximal thrombus locations. The GL can also be beneficial in stent delivery after successful thrombus removal in challenging coronary anatomy cases. Ideally, a randomized trial would be needed comparing GL to coronary aspiration catheters to prove its superiority in thrombus removal.
- O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial InfarctionA Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61:e78-e140.
- Kumbhani DJ, Bavry AA, Desai MY, Bangalore S, Bhatt DL. Role of aspiration and mechanical thrombectomy in patients with acute myocardial infarction undergoing primary angioplasty: an updated meta-analysis of randomized trials. J Am Coll Cardiol. 2013;62:1409-18.
- Frobert O, Lagerqvist B, Olivecrona GK, et al. Thrombus aspiration during ST-segment elevation myocardial infarction. New Engl J Med. 2013;369:1587-97.
- Stys AT, Stys TP, Rajpurohit N, Khan MA. A novel application of GuideLiner catheter for thrombectomy in acute myocardial infarction: a case series. J Invasive Cardiol. 2013 Nov;25(11):620-4.
A selection of articles on the topic of Thrombectomy available at http://www.invasivecardiology.com:
- Tasal A, Asil T, Goktekin O. Combined use of invatec mo.ma proximal protection device and Solitaire AB retrievable stent for tandem occlusions in a patient with acute ischemic stroke. J Invasive Cardiol. 2013 Oct;25(10):E194-7.
- Chaudhry MA, Pappy R, Hennebry TA. Use of the trellis device in the management of deep vein thrombosis: a retrospective single-center experience. J Invasive Cardiol. 2013 Jun;25(6):296-9.
- Alaswad K. Carotid artery thrombosis treated with catheter intervention using proximal occlusion and flow reversal. J Invasive Cardiol. 2013 May;25(5):E106-9.
- Bunte MC, Veeravalli LG, Raymond R. Successful thrombectomy for acute coronary thromboembolism during Heartmate II ventricular support. J Invasive Cardiol. 2013 Mar;25(3):E54-6.