Sustained mechanical aspiration thrombectomy for acute coronary syndrome with large thrombus burden: The Aspiration, Vasodilators, Imaging, and Stenting (AVIS) protocol

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice Pub Date : 2025-06-28 DOI:10.1016/j.ahjo.2025.100569

Tanuj Bhatia , Aditya Kapoor , Vishal Rastogi , Rajneesh Kapoor , Nakul Sinha , Rishi Sethi , Kunal Mahajan , Richa Sharma , Roopali Khanna , Sai Devvrat , Vanshaj Sharma

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引用次数: 0

Abstract

Study objective

To evaluate the effectiveness and safety of sustained mechanical aspiration thrombectomy in acute coronary syndrome (ACS) patients with a large thrombus burden (LTB).

Design

This is a prospective observational study.

Setting

A Tertiary Healthcare Center in North India.

Participants

ACS patients with LTB recommended for percutaneous coronary intervention (PCI).

Intervention

Upfront sustained mechanical aspiration thrombectomy with The Indigo™ system CAT™ RX (Penumbra Inc., Alameda, CA) before primary PCI.

Main outcome

Primary outcomes included improvement in thrombolysis in myocardial infarction (TIMI) flow, TIMI thrombus grade, and myocardial blush grade (MBG). Clinical outcomes (death, recurrent MI, stroke) and improvement in LV function were recorded at baseline, 1 month and 6 months.

Results

Among 105 patients (median age 55 years, 82.9 % male), most had grade 5 thrombus (84.8 %), MBG grade 0 (84.8 %), and TIMI grade 0 flow (82.9 %) at baseline. After the procedure, significant improvements were observed in TIMI flow, TIMI thrombus grade, and MBG (p < 0.001). Three deaths were reported within the first 30 days, none of which were device related. There was a significant increase in the mean left ventricular ejection fraction from baseline to six month follow up (38.37 % vs. 44.63; p < 0.001).

Conclusion

Sustained mechanical aspiration thrombectomy effectively removed clots and aided in optimal myocardial perfusion in ACS patients with LTB. This study also proposes the utilization of the Aspiration, Vasodilators, Imaging, Stenting (AVIS) protocol to improve procedural success.

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急性冠脉综合征伴大血栓负荷的持续机械抽吸取栓：抽吸、血管扩张剂、成像和支架植入术（AVIS）方案

研究目的评价持续机械抽吸取栓治疗血栓负荷较大的急性冠脉综合征（ACS）患者的有效性和安全性。本研究为前瞻性观察性研究。印度北部的三级医疗保健中心。参与者建议sacs合并LTB患者行经皮冠状动脉介入治疗（PCI）。介入：首次PCI前，使用Indigo™系统CAT™RX （Penumbra Inc., Alameda， CA）进行持续机械吸入性血栓切除术。主要结局：主要结局包括心肌梗死（TIMI）血流溶栓改善、TIMI血栓分级和心肌红肿分级（MBG）改善。在基线、1个月和6个月时记录临床结果（死亡、复发性心肌梗死、卒中）和左室功能改善。结果105例患者（中位年龄55岁，82.9%为男性），大多数在基线时有5级血栓（84.8%），MBG 0级（84.8%）和TIMI 0级血流（82.9%）。手术后，观察到TIMI血流、TIMI血栓等级和MBG (p <；0.001)。在头30天内报告了3例死亡，其中没有一例与设备有关。从基线到随访6个月，平均左室射血分数显著增加(38.37% vs. 44.63；p & lt;0.001)。结论持续机械抽吸取栓能有效清除ACS合并LTB患者的血栓，促进心肌灌注。本研究还提出利用抽吸、血管扩张剂、成像、支架植入术（AVIS）方案来提高手术成功率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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