Novel use of a guide extension mother-and-child catheter for adjunctive thrombectomy during percutaneous coronary intervention for acute coronary syndromes.

BACKGROUND: The use of adjunctive thrombectomy during primary percutaneous coronary intervention (PCI) has steadily increased with recent trials demonstrating an improved clinical and mortality benefit for manual aspiration thrombectomy. The use of an in-dwelling guide extension mother-and-child catheter allows direct aspiration of thrombus from the vessel with its larger extraction area.

METHODS: Between December 2011 and September 2013, a total of 17 patients who presented with acute coronary syndromes (ACS) in whom a guide extension catheter was utilized specifically for manual thrombus aspiration were identified and studied.

RESULTS: The guide extension catheter was utilized specifically for thrombus aspiration in 18 vessels involving 17 patients presenting with ACS where severe thrombus burden was noted. The cases involved 4 saphenous vein grafts and 14 native coronary arteries, with 4 cases involving vessels with late stent thrombosis. Successful outcomes with thrombus aspiration and TIMI-3 flow were achieved in 17/18 vessels treated, with no adverse outcomes of vessel trauma or strokes noted.

CONCLUSIONS: Adjunctive manual aspiration thrombectomy utilizing a guide extension mother-and-child catheter affords a novel method of thrombus aspiration, offering a larger extraction area within the conventional 6 Fr system, with demonstrated efficacy for vessel lesions with a large thrombus burden.