The treatment of STEMI using balloon angioplasty and stent is problematic because of potential distal embolization, microvascular plugging, decreased myocardial perfusion and higher mortality. Excimer laser coronary atherectomy (ELCA) can facilitate direct stenting in AMI by ablating plaque and dissolving thrombus, potentially minimizing embolization. Also, the use of intracoronary abciximab in AMI can reduce distal embolization, improve TIMI flow and TMPG and reduce infarct size. The ClearWay catheter infuses and contains 2b3a inhibitors such as abciximab within thrombotic occlusions, potentiating the local drug effect 1000-fold. This aids in thrombus dissolution, potentially improving clinical outcomes.
We retrospectively analyzed the strategy of ELCA and/or aspiration thrombectomy combined with intralesional infusion of 2b3a inhibitors using the ClearWay infusion catheter in 42 patients with AMI presenting at Bryn Mawr Hospital between 2008 and 2010. The patients had a mean age of 59 years, 80% were male, 40% had HTN and 35% were smokers. All lesions were 100% occluded with definitive thrombus. Forty-six percent of patients had an anterior MI related to LAD occlusion. Abciximab was used 83% of the time; and eptifibatide, 17%. Laser was used in 81% of the patients. The angiographic characteristics and results in the cath lab following laser/aspiration and ClearWay (L/A/C) are shown in the table below. In this high-risk patient population, TIMI 3 flow was achieved in all the cases; and a final TMPG of 3, in 81% of cases. Our study demonstrates that in patients presenting with AMI, the use of ELCA and intralesional 2b3a inhibition with the ClearWay infusion catheter is safe and effective in restoration of myocardial perfusion. This could potentially translate into better clinical outcomes in the long term and deserves further study in a larger randomized control study.
| TIMI pre | TIMI post L/A/C | TIMI final | TMPG final | |
|---|---|---|---|---|
| 0 | 36 (85%) | 0 | 0 | 0 |
| 1 | 4 (10%) | 1 (3%) | 0 | 0 |
| 2 | 2 (5%) | 5 (12%) | 0 | 8 (19%) |
| 3 | 0 | 36 (85%) | 42 (100%) | 34 (81%) |
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