Does pretreatment with the X-sizer thrombectomy system improve epicardial flow and ST-segment resolution in patients with acute coronary syndrome and suspected intracoronary thrombus undergoing PCI?
Pretreatment with the X-sizer thrombectomy system before PCI in ACS patients with suspected thrombus improves epicardial flow and accelerates ST-segment resolution compared to PCI alone.
BACKGROUND: In patients with acute coronary syndrome (ACS), percutaneous coronary intervention (PCI) may cause thrombus dislodgment followed by reduced flow and impaired microcirculatory function. We prospectively compared conventional PCI to a strategy of additional pretreatment using the X-sizer thrombectomy system. METHODS AND RESULTS: Sixty-six patients (51 77% men; 54.9+/-9.9 years) with ACS (49 with ST-elevation infarction STEMI) and suspected intracoronary thrombus were randomized 1:1 to pretreatment with X-sizer and conventional PCI alone. Various aspects of epicardial flow and microvascular function were studied. Baseline data were similar in both groups. Postprocedural TIMI 3 flow was obtained in 90% of X-sizer-treated patients and in 84% of controls (NS); however, corrected TIMI frame count was lower in X-sizer- treated patients (18.3+/-10.2 versus 24.7+/-14.1; P50% was observed in 83% of X-sizer-treated patients and in 52% of controls (P50% (OR 4.35; 95% CI, 1.13 to 16.9; P<0.04). Major adverse cardiac events after 30 days occurred in 2 patients in each group. CONCLUSIONS: In ACS with suspected thrombus, pretreatment with the X-sizer catheter system improves epicardial flow and accelerates ST-segment resolution compared with conventional PCI alone.
Beran et al. (Tue,) studied this question.