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Percutaneous rotational thrombectomy reduces acute reocclusion in an animal model of acute coronary thrombosis.

This study was designed to compare acute reocclusion rates after treatment of acute coronary thrombosis with a percutaneous thrombectomy device or standard balloon angioplasty. Our group has previously reported on the rationale and development of a mechanical device for the treatment of intra-arterial thrombosis. This device removes fibrin from thrombus, allowing for dissolution of the cellular elements of the thrombus. Theoretically, thrombus removal (as opposed to displacement) might result in a lower rate of acute rethrombosis. The present study utilizes the device percutaneously in the coronary arteries of closed chest swine and compares recanalization and reocclusion rates with standard balloon angioplasty. Twenty-six animals with total thrombotic coronary occlusions were treated; 13 with each device. Reocclusion rates with the thrombectomy device were significantly reduced at 60 min and 120 min after recanalization (p < 0.02), and the mean time to reocclusion was prolonged by 45 min (p = 0.07). Technical problems included poor handling characteristics in early prototypes and stress fractures secondary to improper use. Changes in catheter design and operator protocols have largely eliminated these problems. We conclude that this study demonstrates the feasibility of percutaneous mechanical thrombectomy in the coronary arteries and that reocclusion rates after recanalization of thrombotic occlusions compare favorably to standard angioplasty.