Clinical Study Local Intracoronary Eptifibatide versus Mechanical Aspiration in Patients with Acute ST-Elevation Myocardial Infarction Mohamed A. Hamza, 1,2 Ayman Galal, 1 Salwa Suweilam, 1 and Mohamed Ismail 1 1 Ain Shams University, P.O. Box 11381, Cairo, Egypt 2 Cardiology Department, Ain Shams University, Lotfy Elsayed Street, Abbaseya, P.O. Box 11381, Cairo, Egypt Correspondence should be addressed to Mohamed A. Hamza; matef77@hotmail.com Received 31 December 2013; Accepted 19 May 2014; Published 3 June 2014 Academic Editor: Karl A. Illig Copyright © 2014 Mohamed A. Hamza et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. We compared local delivery of intracoronary eptifbatide via perfusion catheter to thrombus aspiration in primary PCI. Background. Perfusion catheter increases local concentration of the drugs at the culprit site and prolongs their residency time. Methods. 75 patients with acute STEMI were randomized to three groups: 25 received local intracoronary eptifbatide and verapamil via perfusion catheter; 25 patients were managed by Diver CE thrombectomy device and 25 patients by primary PCI without thrombus aspiration. Primary end point was assessment of postprocedural TIMI fow, MPG, and corrected TIMI frame count (cTFC) in the culprit vessel. Results. Perfusion catheter was superior to thrombus aspiration and conventional PCI as regards MBG (68% versus 36% in Diver CE and 20% in the control arm;  value = 0.002), with shorter cTFC rates than thrombectomy and control groups (20.76 ± 4.44 versus 26.68 ± 8.40 and 28.16 ± 5.96, resp.;  = 0.001). TIMI fow was not diferent between the 3 groups. Eptifbatide led to less time to peak CK (13.12 hours versus 16.5 and 19.5 hours, respectively,  value = 0.001). Conclusion. Local intracoronary eptifbatide by perfusion catheter reduces thrombus burden with better results in microvascular perfusion assessed by cTFC and MBG compared to aspiration device or conventional PCI. 1. Introduction Primary percutaneous coronary intervention (PCI) is con- sidered the preferred reperfusion modality for patients pre- senting with ST-segment elevation myocardial infarction (STEMI) regardless of the hour of presentation as long as reperfusion can occur in a timely manner [1]. Yet despite the prompt and successful restoration of ante grade epicardial blood fow by PCI, a signifcant proportion of patients with AMI remain at increased risk of death and adverse outcomes [2]. Also microvascular obstruction with diminished myocardial perfusion occurs in a large proportion of patients with a patent epicardial vessel afer primary PCI, and this event is associated with an increased infarct size, reduced recovery of ventricular function, and increased mortality [3]. Te high frequency of suboptimal myocardial reperfu- sion afer primary PCI has resulted in the development of dif- ferent feasible and safe thrombectomy and distal protection devices. Te efciency and safety of adjunct thrombectomy using Diver CE device (Invatec, Italy) have been established [4]. A promising novel solution to ameliorate the outcome of angioplasty for acute coronary syndromes resides in the combined use of pharmacological and catheter-based therapies to increase local concentration of drugs such as glycoprotein IIb/IIIa inhibitors at the culprit site, prolonging their residency time [5]. Te therapeutic perfusion catheter is a microporous balloon catheter that acts as a low-pressure irrigating system for localized perfusion of therapeutic agents into the coronary vasculature providing up to 500 times the systemic concen- tration of a drug by gently occluding the blood fow and signifcantly increasing the residence time of the infused drug at the specifc target site [6]. We investigated the efcacy of local eptifbatide delivery to the site of thrombus through infusion catheter in compar- ison with thrombus aspiration in patients with acute STEMI undergoing primary PCI. Hindawi Publishing Corporation International Journal of Vascular Medicine Volume 2014, Article ID 294065, 5 pages http://dx.doi.org/10.1155/2014/294065