Shusuke Matsuo

Thrombectomy with AngioJet catheter in native coronary arteries for patients with acute or recent myocardial infarction

The AngioJet thrombectomy catheter removes thrombi by rheolytic fragmentation and suction. The purpose of this study was to identify the efficacy and safety of this new device. Myocardial infarction (MI) is associated with intracoronary thrombus. Intracoronary thrombus has been identified as a risk factor of unfavorable outcome after percutaneous transluminal coronary angioplasty. To what extent the AngioJet is applicable or effective for acute or recent MI in native coronary artery is not clear. Thrombectomy with the AngioJet was attempted in 31 patients with 31 native coronary arteries selected from 304 patients with acute or recent MI. Follow-up angiography was performed at 3 to 6 months. Procedure success was achieved in 29 patients (94%). Adjunctive balloon angioplasty was performed after AngioJet thrombectomy in 30 patients (97%), and in only 1 patient (3%) AngioJet thrombectomy was the sole procedure. Subsequent stenting after balloon angioplasty was attempted successfully in 12 patients (40%) without thrombotic complications. Thrombolysis In Myocardial Infarction trial flow grading increased from 0.70 +/- 0.97 before to 2.61 +/- 0.88 after AngioJet thrombectomy (p <0.0001), to 2.84 +/- 0.64 after adjunctive procedures (p = 0.070). At follow-up angiography restenosis rate was 21% but Thrombolysis In Myocardial Infarction flow 3 was present in all patients. The restenosis rate of stented patients was 8%. There were no major events during in-hospital and follow-up. The AngioJet can be used safely and successfully to remove thrombus from the native coronary artery of patients with MI. Thrombus removal makes subsequent stenting safe and uncomplicated. The restenosis rate was considered to be acceptable.

Stenting after thrombectomy with the AngioJet catheter for acute myocardial infarction

The presence of massive intracoronary thrombi may contraindicate stenting. The AngioJet catheter rheolytic thrombectomy prepared the road for an easy and uneventful stenting in 2 patients with acute myocardial infarction (AMI) and thrombi. This combination provides a promising strategy for patients with AMI and angiographic evidence of massive thrombi.

Feasibility of a rapid protocol of 1-day single-isotope rest/adenosine stress Tc-99m sestamibi ECG-gated myocardial perfusion imaging

BackgroundWe previously developed a new rapid protocol for single-isotope rest/adenosine stress technetium 99m sestamibi (MIBI) electrocardiography-gated myocardial perfusion imaging examination. The feasibility and limitations of this rapid protocol are unclear.Methods and ResultsWe examined 422 patients who underwent rest acquisition, which eliminates the waiting time, after injection of low-dose MIBI and drinking 400 mL of water. The patients immediately underwent adenosine stress. Stress acquisition was performed 1 hour after injection of high-dose MIBI. The sensitivity and specificity for detecting significant coronary stenoses were 93% and 70%, respectively. The frequency of significant (moderate or severe) inferior wall artifacts on the rest single photon emission computed tomography images among all patients was 16.3%. The frequency of significant artifacts in patients aged 70 years or older was significantly lower than that in patients aged less than 70 years (11.9% vs 26.9%, P=.0001). Multivariate analysis revealed that age less than 70 years and prior myocardial infarction were predictors of significant artifacts on resting images (P<.0001 and P<.05, respectively).ConclusionsOur rapid protocol for MIBI myocardial perfusion imaging (MPI) provides high-quality images and good patient throughput, and it is effective at reducing the total examination time.