Primary percutaneous coronary intervention was performed in standard fashion with the use of adjunctive manual thrombectomy at the operator’s discretion in participants with high thrombus burden. After flow was established in the culprit artery with a 0.014’ angioplasty wire, manual thrombectomy was performed using a conventional 6 French compatible thrombus aspiration catheter - Export (Medtronic), Vmax (Stron Medical), or Hunter (IHT Cordynamic). The chosen thrombectomy device was advanced proximal to the culprit lesion under fluoroscopic guidance and then manoeuvred gently forward and backward while vacuum-based-suction was applied with a 20 ml Luer-lock syringe connected to the proximal hub of the thrombectomy catheter. The aspirate was filtered using a 40 μm pore cell strainer (BD Falcon, Milan, Italy) and collected thrombotic debris was gently washed with normal saline to remove excess blood. The debris within the filter was frozen at −80°C. For this study, a thrombectomy was considered “successful” when the actual aspirated thrombus was representative of the expected thrombus based on the angiographic thrombus burden (see Section “Angiographic analysis”).
Export
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4 protocols using export
1
Thrombectomy in Primary PCI for STEMI
2
ECG Assessment During PPCI Procedure
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We studied the ECG traces from 289 patients whose PPCI procedures were being audited at our institution. A standard Witt biomedical ECG system, used in our angiography laboratory, was used for all ECG recordings. A 12-lead trace was recorded at the start of the PPCI procedure immediately after the patient was connected up (ECG A). Furthermore, 12-lead ECG traces were recorded 30 s after passage of an angioplasty guidewire (ECG B) and 30 s after a thrombus aspiration catheter had been removed from the coronary artery (ECG C). A further trace was evaluated when the angioplasty operator deemed that the case was finished (ECG F).
All patients were loaded with aspirin 300 mg and clopidogrel 600 mg (given by the paramedics in the ambulance or in the emergency department). Unfractionated heparin (70 U/kg) was given once arterial access was obtained. The thrombus aspiration catheters used were the EXPORT (Medtronic) and the HUNTER (IHT Cordynamic). The use of adjunctive therapy (tirofiban) was at the discretion of the operator and typically given after thrombus aspiration had been performed.
All patients were loaded with aspirin 300 mg and clopidogrel 600 mg (given by the paramedics in the ambulance or in the emergency department). Unfractionated heparin (70 U/kg) was given once arterial access was obtained. The thrombus aspiration catheters used were the EXPORT (Medtronic) and the HUNTER (IHT Cordynamic). The use of adjunctive therapy (tirofiban) was at the discretion of the operator and typically given after thrombus aspiration had been performed.
3
Interventional Cardiology: Antiplatelet and Thrombectomy Protocols
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Our institution is a high-volume tertiary referral center for interventional cardiology, with an average of 2500 PCIs performed per year. Antiplatelet therapy followed institutional routines for STEMI: 300 mg aspirin and 300–600 mg clopidogrel on hospital admission. Heparin (60–100 U/kg) was administered before coronary guide wire introduction, and all procedures were performed according to standard pPCI techniques [29] , [30] (link).
The decision to perform thromboaspiration during the pPCI procedure was made at operator discretion, as were technical aspects such as type and number of stents, use of any other devices, and glycoprotein IIb/IIIa use. Aspiration thrombectomy was performed with one of the following devices: Export (Medtronic Vascular Inc., Santa Rosa, CA), Diver (INVATEC, Brescia, Italy), or Pronto (Vascular Solutions, Minneapolis, MN). In every case, aspiration was attempted before balloon dilatation (as in the TAPAS trial) [31] (link), and several passages at the site of occlusion were performed. Aspirated blood and intracoronary material were collected in the filter.
The decision to perform thromboaspiration during the pPCI procedure was made at operator discretion, as were technical aspects such as type and number of stents, use of any other devices, and glycoprotein IIb/IIIa use. Aspiration thrombectomy was performed with one of the following devices: Export (Medtronic Vascular Inc., Santa Rosa, CA), Diver (INVATEC, Brescia, Italy), or Pronto (Vascular Solutions, Minneapolis, MN). In every case, aspiration was attempted before balloon dilatation (as in the TAPAS trial) [31] (link), and several passages at the site of occlusion were performed. Aspirated blood and intracoronary material were collected in the filter.
4
Intracoronary Thrombus Aspiration Protocol
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Patients underwent the procedure according to the operator's usual technique. After cannulating the involved coronary artery by guiding catheter, the lesion was crossed with a guidewire and the Export (Medtronic) aspiration catheter was advanced and suction started before it crossed the lesion. The first intracoronary blood suctioned was sent for arterial blood gas (ABG) analysis. It was made sure that the guide catheter be fully engaged with the coronary ostium during removal of the aspiration catheter to avoid embolizing thrombus to the systemic vasculature. The percutaneous coronary intervention procedure was performed after aspiration was completed. At the very same time, blood from peripheral artery was also sent for ABG analysis. ABG analysis was performed by using instrument, GEM Premier 3000. Heparinized 2 ml of Intracoronary and peripheral blood sample was used for analysis. Parameters analysed included pH, lactate, bicarbonate levels and partial pressures of carbon dioxide (pCO2) and oxygen (pO2).
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