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document
Thrombus aspiration reduces microvascular obstruction after primary coronary intervention : a myocardial contrast echocardiography substudy of the REMEDIA Trial . OBJECTIVES The aim of this study was to clarify the role of microembolization in the genesis of microvascular obstruction ( MO ) after percutaneous coronary intervention ( PCI ) . BACKGROUND Fifty consecutive patients entered the myocardial contrast echocardiography ( MCE ) substudy of the REMEDIA ( Randomized Evaluation of the Effect of Mechanical Reduction of Distal Embolization by Thrombus Aspiration in Primary and Rescue Angioplasty ) trial , which defined the role of a new thrombus-aspirating device in preventing distal microembolization after PCI . METHODS A total of 25 patients were randomized to be pretreated with thrombus aspiration before PCI of the culprit lesion and 25 received standard PCI . At 24 h , 1 week , and 6 months after PCI , MCE was performed by Sonovue , and real-time imaging was performed by contrast pulse sequencing technology . Regional wall motion score index ( WMSI ) , contrast score index ( CSI ) , endocardial length of wall motion abnormality ( WML ) and contrast defect ( CDL ) , end-diastolic and end-systolic left ventricular ( LV ) volumes , and ejection fraction were calculated . RESULTS At each time point , in patients treated with a thrombus-aspiration filter device , WMSI , CSI , WML , and CDL were significantly lower and ejection fraction higher ( p < 0.05 vs. control patients ) , whereas LV volumes were slightly but not significantly smaller compared with control patients . In the overall study population , the extent of MO significantly correlated with temporal changes in LV volumes . CONCLUSIONS Thrombus aspiration used at the time of PCI significantly reduces the extent of MO and myocardial dysfunction , although it does not have a significant favorable effect in preventing LV remodeling . Thus , the beneficial effect of thrombus aspiration occurs at the microvascular level , but additional mechanisms may play a role in influencing the final extent of MO , which strictly correlates with post-infarct LV remodeling .
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Intervention_Surgical
thrombus aspiration before PCI of the culprit lesion and
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Intervention_Physical
standard PCI .
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Outcome_Physical
microvascular obstruction
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Outcome_Physical
microvascular obstruction ( MO )
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Outcome_Physical
microembolization
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Outcome_Physical
Regional wall motion score index ( WMSI ) , contrast score index ( CSI ) , endocardial length of wall motion abnormality ( WML ) and contrast defect ( CDL )
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Outcome_Physical
end-diastolic and end-systolic left ventricular ( LV ) volumes
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Outcome_Physical
ejection fraction
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Outcome_Physical
WMSI , CSI , WML , and CDL
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Outcome_Physical
ejection fraction
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Outcome_Physical
LV volumes
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Outcome_Physical
extent of MO
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Outcome_Physical
LV volumes
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Outcome_Physical
extent of MO
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Outcome_Physical
myocardial dysfunction
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Outcome_Physical
LV remodeling
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Outcome_Physical
MO
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Outcome_Physical
LV remodeling
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Participant_Condition
primary coronary intervention :
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Participant_Sample-size
Fifty
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Participant_Sample-size
25
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Participant_Sample-size
25