Use of a thrombus extraction catheter (Thrombuster II®) in an acute myocardial infarction

In the primary percutaneous intervention (PCI) of an acute ST elevated myocardial infarct (STEMI), the microvascular clogging caused by embolisation of thrombotic or atheromatous debris can affect the myocardial tissue perfusion to increase the infarct size and reduce survival. In the catheterisation laboratory this usually manifests itself by sub-optimal angiographic capillary opacification (myocardial blush) or delayed ST-segment resolution with an inappropriate enzyme rise. To circumvent this problem there are a number of thrombectomy and distal protection devices currently available. However, the usefulness of thrombectomy as an adjunct therapy during primary PCI remains contentious. In some pilot studies, and in small-randomised trials, there have been promising results with good microcirculation blush, improved left ventricular function, and enhanced event-free survival, whilst in others there was no significant benefit. Probable reasons for failure could be have been due to the inefficiency of the device; high thrombotic burden suggesting more appropriate use in a selected patient population and the late clinical presentation meant that the aspirating a thrombus in vessel associated with a transmural infarction offered little benefit. The Thrombuster II (Kaneka Corp. Japan) is a thrombectomy device that offers a low frictional resistance. This together with it's large circular lumen can provide superior aspiration ability. This technical report details the device and its use in an acute ST-elevated infarction.