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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
Case ExamplesEducational Content

ATHERECTOMY COMPLICATIONS

Case ExamplesEducational Content

BYPASS GRAFT COMPLICATIONS

ModelBurst (ATM)Diameter (mm)Balloon Length (mm)              
681215202530
MINI TREK (CTO INDICATED)1.271.2
1.561.5
2.172✓*✓*
TREK2.372.25
2.672.5
2.912.75
3.113
3.53.25
3.73.5
3.943.75
4.324
4.864.5
5.365
*Only available as RX, not as OTW. Other sizes available in both versions.
Retrieved on April 07 2022 from Abbott product ordering information. Please look at the company's files for the latest available data on device configurations and avilability in your area.

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