Special Feature

Select abstracts from Cardiovascular Research Technologies (CRT) 2012,February 4–7, Washington, DC

Intracoronary administration of abciximab via an intracoronaryperfusion catheter in patients with a thrombotic coronaryocclusion—a single center experienceChristian Roth, Georg Delle-Karth, Irene Lang, Gerhard Kreiner,Clemens Gangl, Rudolf Berger, Thomas NeunteuflMedical University of Vienna, Vienna, Austria

Aims: At concentrations superior to those achieved with thestandard intravenous dose for coronary procedures, abciximab hasan active dethrombotic effect by displacing platelet-bound fibrino-gen. This analysis investigates whether administration of abciximabby local intracoronary infusion through the ClearWay (CX) RXperfusion catheter improves coronary blood flow (TIMI flow) byreducing thrombus burden.Methods and Results: This retrospective study included 68 patientswho presented with an acute coronary syndrome due to anintracoronary thrombus between May 2009 and April 2011. Theprimary endpoint was defined as improvement in Thrombolysis InMyocardial Infarction (TIMI) flow after intracoronary application ofabciximab via the ClearWay (CW) RX perfusion catheter. Thepopulation (mean age 58±11 years) consisted of 54 patients (79%)with an ST-elevation myocardial infarction and 14 patients (21%)with a non-ST-elevation myocardial infarction. The balloon-diameterof the perfusion catheter was 1 mm in 25 (37%), 1.5 mm in 23 (34%),2.0 mm in 14 (20%), and 3.0 mm in 6 patients (9%), respectively.Successful positioning of the balloon within the thrombus was notpossible in 4 patients (6%). After infusion of abciximab using theperfusion catheter TIMI flow improved by one grade in 17 patients(25%), by two grades in 9 patients (13%), and by three grades in 7patients (10%), TIMI flow remained unchanged in 21 patients (31%),and even worsened by one grade in 4 patient (6%) (χ2 test, Pb.001).The procedure was complicated by an air embolization in 5 patients(7%). Air embolization occurred using a 2 mm balloon (threepatients) or a 3 mm balloon (two patients), but not using a 1 mmor 1.5 mm balloon (χ2, Pb.003). After the use of the perfusioncatheter in these patients TIMI flow improved by one degree in 2 ofthese patients, was unchanged in 2 of these patients and worsened byone grade in one patient. After additional treatment with throm-bectomy (54 patients, 79%), initial balloon dilatation (46 patients,68%), direct stenting (22 patients, 32%), and stent implantation (64patients, 94%), the final TIMI flow was TIMI 3 in 57 patients (84%),TIMI 2 in 4 patients (6%), TIMI 1 in 6 patients (9%), and TIMI 0 in 1patient (1%).Conclusion: The intracoronary infusion of abciximab using theClearWay (CX) RX perfusion catheter helps to improve myocardial

perfusion in patients with acute coronary syndrome due to anintracoronary thrombus. The use of perfusion catheters with aballoon ≥2 mm can be associated with air embolism.

doi:10.1016/j.carrev.2012.01.012

Combined treatment of thrombotic coronary occlusions bythrombectomy and by intracoronary administration of abciximabvia an intracoronary perfusion catheter—which treatment first?Christian Roth, Georg Delle-Karth, Irene Lang, Gerhard Kreiner,Clemens Gangl, Rudolf Berger, Thomas NeunteuflMedical University of Vienna, Vienna, Austria

Purpose: Thrombectomy and intracoronary administration of abci-ximab via an intracoronary perfusion catheter have been demon-strated to reduce thrombus burden. We analyzed two differenttreatment strategies: (1) first thrombus-aspiration to reduce throm-bus size, then lysis of the rest-thrombus by locally administered abci-ximab via the ClearWay (CW) RX perfusion catheter versus (2) firstpharmacological thrombus-reduction by locally administered abci-ximab, then, if necessary, thrombus-aspiration of the rest-thrombus.Methods: This retrospective study included 68 patients who pre-sented with an acute coronary syndrome due to an intracoronarythrombus between May 2009 and April 2011. Thrombus-aspirationfirst strategy was performed in 39 patients, abciximab first strategy in29 patients. The primaryendpointwas defined as final improvement inThrombolysis In Myocardial Infarction (TIMI) flow.Results: Before treatment TIMI flow was similar between the twotreatment groups (TIMI flow 0 in 28 and 21 patients (72/72%), 1 in 6and 1 patients (15/4%), 2 in 2 and 4 patients (5/14%), 3 in 3 and 3patients (8/10%), n.s.). In the thrombus-aspiration first group localabciximab administration improved TIMI flow by one stage in 26% ofpatients, by two stages in 3% of patients, and by three stages in 5% ofpatients, and did not improve TIMI stage in 46% of patients. In thisgroup TIMI improvement was not documented in 8 patients (20%). Inthe abciximab first group local abciximab administration improvedTIMI flow by one stage in 24% of patients, by two stages in 28% ofpatients, and by three stages in 17% of patients, and did not improveTIMI stage in 24% of patients. In this group TIMI improvement was notdocumented in 2 patients (7%). In the abciximab first group additionalthrombus aspiration was performed in 15 patients (52%), whereas inthe thrombus-aspiration first group all patients were additionallytreated with local abciximab administration (χ2, Pb.007). Final TIMIflow was significantly better in the abciximab first group (TIMI flow 0

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Cardiovascular Revascularization Medicine

1553-8389/$ – see front matterdoi:10.1016/j.carrev.2012.01.007

Cardiovascular Revascularization Medicine 13 (2012) e3–e19