الفهرس 
Unstable Angina and Non-ST Segment Elevation Myocardial InfarctionOnly 14 pages are availabe for public view
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Abstract
Thrombus aspiration is an effective adjunctive therapy to prevent distal embolization during percutaneous coronary intervention (PCI) in patients having visible thrombus in their coronary angiography.
Our aim was to compare between the short term-outcome of thrombectomy by (Diver CE) thrombus aspiration catheter with or without tirofiban versus Tirofiban alone in patients undergoing PCI for thrombus containing lesion in the setting of NSTEMI and unstable angina patients.
Sixty patients admitted at Kobry El Kobba Military Hospital, Maadi Military Hospital and Ain Shams University Hospital with acute coronary syndromes (non-ST segment elevation myocardial infarction and unstable angina) with angiographically visible thrombus during coronary angiography.
Those patients were selected according to the fact that they met the inclusion criteria; however, the original cohort number was 180 patients. Out of the 60 patients selected, 46 were presenting as NSTEMI and the rest 14 were presenting as unstable angina.
Then the patients were divided into three groups after having coronary angiography:
First group:
Twenty patients (with visible thrombus on their coronary angiography) managed by Tirofiban for 48 hours followed by PCI.
Second group:
Twenty patients managed by thrombus aspiration with (Diver CE) aspiration catheter with concomitant use of tirofiban and PCI immediately.
Third group:
Twenty patients managed by thrombus aspiration with (Diver CE) and PCI immediately without the use oftirofiban.
The patients were evaluated for the following end points:
• TIMI flow score.
• Myocardial blush grade.
• Angiographically visible embolization after the procedure.
• In hospital acute & sub-acute thrombosis.
• In hospital bleeding.
• Enzymatic workup.
• Echocardiographic assessment, (on discharge & after one month).
• MACE, (In hospital & after one month).
The results of the current study showed that effective manual aspiration of atherothrombotic material was feasible in a majority of patients presenting with myocardial infarction with non-ST-segment elevation myocardial infarction and unstable angina.
As compared with PCI, aspiration resulted in improved myocardial reperfusion, documented by improvement in TIMI flow score, the clear improvement in the myocardial blush grade and rarity of the presence of angiographic visible embolus after the end of the procedure in the thrombus aspiration groups.
On comparing the echocardiographic parameters, the aspiration groups showed significant improvement of the ejection fraction at one month follow up when compared with the conventional PCI group.
As regards enzymatic work up, the peak creatine kinase-MB value was significantly higher in group 1 when compared to aspiration groups and at the same time the decrease of peak creatine kinase –MB was rapid in the aspiration groups when compared with the conventional PCI group.
As regard MACE on discharge and after one month, they were lower in the aspiration groups when compared with conventional PCI group.
Both aspiration groups were nearly similar in results involving the angiographic markers of reperfusion (TIMI flow score and MBG), enzymatic work up and Echocardiographic parameters.
However ,we recorded a case of cerebral hemorrhage in the second group in which tirofiban was used with aspiration and it was for an old age man, the fact that support the concept of using aspiration strategy specially in old age patients in hope of minimizing the risk of bleeding.
At the end, we summarize that the use of thrombus aspiration catheter (Diver CE) in NSTEMI and unstable angina patients with angiographically visible thrombus carries great benefits of improving the angiographic markers of reperfusion and the early and late outcomes.