Thrombectomy
Aspiration thrombectomy is being used in acute or subacute coronary thrombotic lesions to remove thrombi from the coronary vasculature during PCI.
Different types of thrombectomy;
- Manual aspiration thrombectomy (Pronto [Teleflex], export aspiration catheters [Medtronic], FETCH 2 Aspiration catheter [Boston Scientific], eliminate Aspiration catheter [Terumo], ASAP Aspiration catheter [Merit Medical], QuickCat Extraction catheter [Philips]): Suction created by a syringe
- Mechanical aspiration thrombectomy(Penumbra): Mechanical power aspiration with a continuous vacuum source and large lumen aspiration catheter
- Rheolytic Thrombectomy (Angioject): A high velocity saline creating a low pressure zone (Bernoulli principle) to create a vacuum
Mechanism
- Mechanical devices pulverize the thrombus with a jet of saline and aspirate through other ports by the mechanism of Venturi–Bernouli effect
- Manual device aspirate by negative suction with a 30 cc locking syringe
Pronto
- It is a manual aspiration device that is connected to 30 cc locking syringe to create negative suction, followed by slow pull back movement
- After the catheter is removed, the back end of the guide is opened, and a generous amount of bleed back is allowed
- Minimum of 2–3 runs are required
ANGIOJET Ultra Coronary Thrombectomy System (Boston Scientific)
Angioject thrombectomy use a high velocity saline creating a low pressure zone to create a vacuum followed by aspiration via distal port.
Indications
- STEMI in setting of primary PCI
- Vein graft intervention with large thrombus
- Coronary ectasia/aneurysm with thrombus and requiring intervention
- For drug delivery in distal vessel
Disadvantages
- Difficult to deliver in tortuous vessels, distal segment, and calcified vessels
- Dissection
- Migration of thrombus
- Stent deformation (proximal) if attempt is made to pass beyond the stent
Model
Distaflex
XMI
Spiroflex
Spiroflex VG
Indication
Coronary arteries & SVGs
Coronary arteries & SVGs
Coronary arteries & SVGs
Coronary arteries & SVGs
Delivery Platform
OTW
OTW
RX
RX
Minimum Vessel Diameter
2 mm
2 mm
2 mm
3 mm
Catheter Length
145 cm
135 cm
135 cm
135 cm
Catheter Diameter
4F/3F
4F
4F
5F
Guide Wire
0.014"
0.014"
0.014"
0.014"
Guide Catheter
6F > .070"
6F > .068"
6F > .070"
7F > .076"
Flow Rate
23 mL/min
40 mL/min
40 mL/min
60 mL/min
Maximum Total Run Time
600 sec
600 sec
600 sec
600 sec
Maximum Run Times with Blood Flow
300 sec
300 sec
300 sec
300 sec
Table: Various types of AngioJet devices
