(Hellenic Journal of Cardiology) HJC • 27 Hellenic J Cardiol 2010; 51: 27-36 Manuscript received: January 26, 2009; Accepted: July 30, 2009. Address: Petros Dardas St. Luke’s Hospital, Panorama 55236 Thessaloniki, Greece e-mail: pdardas@otenet.gr Key words: Rheolytic thrombectomy, coronary intervention, intracoronary thrombus Original Research Original Research Rheolytic Thrombectomy in Patients with Acute Coronary Syndrome and Large Thrombus Burden: Initial and Mid-Term Results from a Single Centre Experience Petros DarDas 1 , Nikos Mezilis 1 , Vlasis NiNios 1 , GeorGios k. efthiMiaDis 1 , DiMitrios tsikaDeris 1 , efstathios PaGourelias 2 , ChristoDoulos Pliakos 2 1 Department of Cardiology and Cardiothoracic Surgery, St. Luke’s Hospital, 2 Cardiology Department, AHEPA Hospital, Thessaloniki, Greece Introduction: The presence of a large intracoronary thrombus burden is a major complicating factor during percutaneous coronary intervention (PCI) in patients with an acute coronary syndrome (ACS). The use of rheolytic thrombectomy (RT) has been proposed to prevent thrombus-related complications, with conflicting results. The purpose of this study was to identify the feasibility and safety of this approach. Methods: We conducted a single-centre, retrospective, observational case-control study, comparing the outcomes of PCI in 26 consecutive patients with ACS and a large thrombus burden who underwent RT to those of a control group of 26 patients, matched with regard to artery location and initial TIMI flow grade. Results: Despite the higher prevalence of acute ST-elevation myocardial infarction and the larger thrombus burden in the RT group, there was less incidence of distal embolisation/no-reflow and less use of vasoactive intracoronary agents. The final TIMI flow was identical in both groups. There was no difference between the two groups in the in-hospital and mid-term incidence of major adverse coronary events. Conclusions: In this study, the use of RT in patients with a large thrombus burden during acute PCI was both feasible and safe and reduced the incidence of initial no-reflow phenomenon. P ercutaneous coronary intervention (PCI) involving balloon angio- plasty and stenting is an effective treatment for acute coronary syndrome (ACS), including ST-elevation myocardial infarction (STEMI) and unstable angina. Despite the technique’s efficacy, procedur- al complications such as reduced coronary flow/no-reflow and distal embolisation frequently occur, especially when a large amount of intracoronary thrombus is pres- ent. 1,2 Plugging of the distal microvascula- ture causes mechanical obstruction of flow and also induces a secondary inflammatory response in the injured myocardium. 3,4 These phenomena may occur even with attainment of thrombolysis in myocardial infarction (TIMI) grade 3 flow. Mechanical treatment of thrombotic lesions by means of thrombectomy and distal or proximal protection devices has been proposed to prevent the complica- tions caused by thrombi. Early studies demonstrated superior procedural and clinical outcomes in patients treated with the Angiojet rheolytic thrombectomy (RT) device (Possis Medical, Inc., Minneapolis, Minnesota, USA), in terms of reducing thrombus burden and improving coronary flow. 5-7 However, in a recent randomised trial, patients with STEMI who were treated with Angiojet application followed