The Experts below are selected from a list of 35127 Experts worldwide ranked by ideXlab platform
Aimee K Armstrong - One of the best experts on this subject based on the ideXlab platform.
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superior vena cava Thrombectomy with the x sizer catheter system in a child with fontan palliation
Catheterization and Cardiovascular Interventions, 2007Co-Authors: Jeffrey G Gossett, Albert P Rocchini, Aimee K ArmstrongAbstract:A 4-year-old female with hypoplastic left heart syndrome and Fontan palliation presented with severe neurologic impairment from thrombosis of the superior vena cava (SVC). She underwent successful SVC Thrombectomy with the X-SIZER® Thrombectomy Catheter System, followed by balloon angioplasty. She demonstrated rapid improvement in her neurologic deficits after the procedure. This represents the first published use of the X-SIZER in a child and its first published use for SVC Thrombectomy. © 2006 Wiley-Liss, Inc.
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Superior vena cava Thrombectomy with the X‐SIZER® catheter system in a child with Fontan palliation
Catheterization and Cardiovascular Interventions, 2007Co-Authors: Jeffrey G Gossett, Albert P Rocchini, Aimee K ArmstrongAbstract:A 4-year-old female with hypoplastic left heart syndrome and Fontan palliation presented with severe neurologic impairment from thrombosis of the superior vena cava (SVC). She underwent successful SVC Thrombectomy with the X-SIZER® Thrombectomy Catheter System, followed by balloon angioplasty. She demonstrated rapid improvement in her neurologic deficits after the procedure. This represents the first published use of the X-SIZER in a child and its first published use for SVC Thrombectomy. © 2006 Wiley-Liss, Inc.
Giuseppe De Luca - One of the best experts on this subject based on the ideXlab platform.
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a meta analytic overview of Thrombectomy during primary angioplasty
International Journal of Cardiology, 2013Co-Authors: Giuseppe De Luca, Eliano Pio Navarese, Harry SuryapranataAbstract:INTRODUCTION: Even though primary angioplasty restores TIMI 3 flow in more than 90% of STEMI patients, the results in terms of myocardial perfusion are still unsatisfactory in a relatively large proportion of patients. Great interest has been focused in the last years on distal embolization as major determinant of poor reperfusion and clinical outcome after primary angioplasty. The aim of this article is to perform an updated meta-analysis of Thrombectomy devices in STEMI patients undergoing primary angioplasty. METHODS: The literature was scanned by formal searches of electronic databases (MEDLINE, Pubmed) from January 1990 to December 2010, the scientific session abstracts (from January 1990 to December 2010) and oral presentation and/or expert slide presentations (from January 2002 to December 2010) (on TCT, AHA, ESC, ACC and EuroPCR websites). No language restrictions were enforced. RESULTS: A total of 21 randomized trials were finally included in the meta-analysis, involving 4514 patients (2270 or 50.3% randomized to Thrombectomy and 2244 or 49.7% to standard angioplasty). Overall Thrombectomy did not reduce 30-day mortality, with more benefits observed only with manual Thrombectomy. No difference was observed in the 30-day reinfarction rate, whereas a trend in higher risk of stroke was observed with Thrombectomy (p=0.06). Manual but not mechanical Thrombectomy significantly improved postprocedural TIMI 3 flow, however, both devices significantly improved myocardial reperfusion as evaluated by ST-segment resolution. By meta-regression analysis a linear relationship was observed between benefits from Thrombectomy in ST-segment resolution and in the presence of thrombus at baseline angiography (p=0.0016). CONCLUSIONS: The present meta-analysis has demonstrated that, among patients with STEMI, manual Thrombectomy significantly improved myocardial perfusion, with a trend in short-term mortality benefits, whereas mechanical Thrombectomy, despite the benefits in myocardial perfusion, did not impact on short-term survival. However, the benefits in myocardial perfusion were significantly related to prevalence of coronary thrombus. In light of the observed higher risk of stroke, Thrombectomy cannot be routinely recommended, but should be used in case of evident intracoronary thrombus. Mechanical Thrombectomy devices may be considered as well to further improve reperfusion and facilitate optimal stent implantation, especially in the presence of large thrombus burden.
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Thrombectomy During Primary Angioplasty: Methods, Devices, and Clinical Trial Data
Current Cardiology Reports, 2010Co-Authors: Giuseppe De Luca, Monica Verdoia, Ettore CassettiAbstract:Distal embolization is a relatively common complication in primary angioplasty and is associated with poor perfusion and higher mortality. The aim of this article is to critically review literature on Thrombectomy devices to prevent distal embolization in patients undergoing primary angioplasty. Several manual and mechanical devices have been proposed. Although negative data have been observed with mechanical devices, significant impact on mortality has been observed with routine use of manual Thrombectomy devices, due to an improvement in myocardial perfusion and reduction in distal embolization. Therefore, routine adjunctive manual Thrombectomy devices should be recommended in the setting of ST-segment elevation myocardial infarction, whereas the use of larger manual Thrombectomy devices (7F) or mechanical devices may be considered in patients with large thrombotic burden to provide more guarantees for complete thrombus removal.
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adjunctive manual Thrombectomy improves myocardial perfusion and mortality in patients undergoing primary percutaneous coronary intervention for st elevation myocardial infarction a meta analysis of randomized trials
European Heart Journal, 2008Co-Authors: Giuseppe De Luca, Dariusz Dudek, Gennaro Sardella, Paolo Marino, Bernard Chevalier, Felix ZijlstraAbstract:Aims The benefits of adjunctive mechanical devices to prevent distal embolization in patients with acute myocardial infarction (AMI) are still a matter of debate. Growing interests are on manual Thrombectomy devices as compared with other mechanical devices. In fact, they are inexpensive and user-friendly devices, and thus represent an attractive strategy. The aim of the current study was to perform an updated meta-analysis of randomized trials conducted with adjunctive manual Thrombectomy devices to prevent distal embolization in AMI. Methods and results The literature was scanned by formal searches of electronic databases [MEDLINE, CENTRAL, EMBASE, and The Cochrane Central Register of Controlled trials (http://www.mrw.interscience.wiley.com/cochrane/Cochrane\_clcentral\_articles_ fs.html)] from January 1990 to May 2008, the scientific session abstracts (from January 1990 to May 2008) and oral presentation and/or expert slide presentations (from January 2002 to May 2008) [on transcatheter coronary therapeutics (TCT), AHA (American Heart Association), ESC (European Society of Cardiology), ACC (American College of Cardiology) and EuroPCR websites]. We examined all randomized trials on adjunctive mechanical devices to prevent distal embolization in AMI. The following keywords were used: randomized trial, myocardial infarction, reperfusion, primary angioplasty, rescue angioplasty, Thrombectomy, thrombus aspiration, manual Thrombectomy, Diver catheter, Pronto catheter, Export catheter, thrombus vacuum aspiration catheter. Information on study design, type of device, inclusion and exclusion criteria, number of patients, and clinical outcome was extracted by two investigators. Disagreements were resolved by consensus. A total of nine trials with 2417 patients were included [1209 patients (50.0%) in the manual Thrombectomy device group and 1208 (50%) in the control group]. Adjunctive manual Thrombectomy was associated with significantly improved postprocedural TIMI (thrombolysis in myocardial infarction) 3 flow (87.1 vs. 81.2%, P < 0.0001), and postprocedural MBG 3 (myocardial blush grade 3) (52.1 vs. 31.7%, P < 0.0001), less distal embolization (7.9 vs. 19.5%, P < 0.0001), and significant benefits in terms of 30-day mortality (1.7 vs. 3.1%, P = 0.04). Conclusion This meta-analysis demonstrates that, among patients with AMI treated with percutaneous coronary intervention, the use of adjunctive manual Thrombectomy devices is associated with better epicardial and myocardial perfusion, less distal embolization and significant reduction in 30-day mortality. Thus, adjunctive manual Thrombectomy devices, if not anatomically contraindicated, should be routinely used among STEMI (ST-segment elevation myocardial infarction) patients undergoing primary angioplasty.
Sanjit S. Jolly - One of the best experts on this subject based on the ideXlab platform.
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The Role of Manual Aspiration Thrombectomy in Patients Undergoing Primary Percutaneous Coronary Intervention for STEMI
Current Cardiology Reports, 2016Co-Authors: Aiman Alak, Sanjit S. JollyAbstract:In STEMI, primary PCI restores macrovascular coronary blood flow effectively but microvascular perfusion remains a challenge. Thrombus has the potential to embolize to the microvasculature limiting effective coronary blood flow. Thrombus burden is associated with a higher mortality and manual aspiration Thrombectomy has the potential to reduce thrombus burden. The first large trial of routine aspiration Thrombectomy (TAPAS, N = 1071) showed an improvement in myocardial blush and an unexpected reduction in mortality. Reinforcing the enthusiasm for this finding meta-analysis of small trials also showed a reduction in mortality, which led to routine manual Thrombectomy becoming a class IIa recommendation in the American and European Guidelines for STEMI. Subsequently; however, large trials such as TOTAL ( N = 10,732) and TASTE ( N = 7244) and meta-analysis showed an increase in the risk of stroke with routine manual Thrombectomy but no improvement in mortality, myocardial infarction, stent thrombosis, or severe heart failure. As such, manual Thrombectomy should not be routinely used instead saving it as a bailout procedure as indicated.
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randomized trial of primary pci with or without routine manual Thrombectomy
The New England Journal of Medicine, 2015Co-Authors: Sanjit S. Jolly, Salim Yusuf, Brandi Meeks, J Pogue, Sasko Kedev, Lehana Thabane, Goran Stankovic, Raul Moreno, Anthony H Gershlick, Saqib ChowdharyAbstract:The primary outcome occurred in 347 of 5033 patients (6.9%) in the Thrombectomy group versus 351 of 5030 patients (7.0%) in the PCI-alone group (hazard ratio in the Thrombectomy group, 0.99; 95% confidence interval [CI], 0.85 to 1.15; P = 0.86). The rates of cardiovascular death (3.1% with Thrombectomy vs. 3.5% with PCI alone; hazard ratio, 0.90; 95% CI, 0.73 to 1.12; P = 0.34) and the primary outcome plus stent thrombosis or target-vessel revascularization (9.9% vs. 9.8%; hazard ratio, 1.00; 95% CI, 0.89 to 1.14; P = 0.95) were also similar. Stroke within 30 days occurred in 33 patients (0.7%) in the Thrombectomy group versus 16 patients (0.3%) in the PCI-alone group (hazard ratio, 2.06; 95% CI, 1.13 to 3.75; P = 0.02). Conclusions In patients with STEMI who were undergoing primary PCI, routine manual Thrombectomy, as compared with PCI alone, did not reduce the risk of cardiovascular death, recurrent myocardial infarction, cardiogenic shock, or NYHA class IV heart failure within 180 days but was associated with an increased rate of stroke within 30 days. (Funded by Medtronic and the Canadian Institutes of Health Research; TOTAL ClinicalTrials.gov number, NCT01149044.)
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design and rationale of the total trial a randomized trial of routine aspiration Thrombectomy with percutaneous coronary intervention pci versus pci alone in patients with st elevation myocardial infarction undergoing primary pci
American Heart Journal, 2014Co-Authors: Sanjit S. Jolly, Salim Yusuf, Brandi Meeks, Lehana Thabane, John A Cairns, Olga Shestakovska, Kari Niemela, Philippe Gabriel Steg, Olivier F Bertrand, Alvaro AvezumAbstract:Background A major limitation of primary percutaneous coronary intervention (PPCI) for the treatment of ST-elevation myocardial infarction (STEMI) is impaired microvascular perfusion due to embolization and obstruction of microcirculation with thrombus. Manual Thrombectomy has the potential to reduce distal embolization and improve microvascular perfusion. Clinical trials have shown mixed results regarding Thrombectomy. Objective The objective of this study is to evaluate the efficacy of routine upfront manual aspiration Thrombectomy during PPCI compared with percutaneous coronary intervention alone in patients with STEMI. Design This is a multicenter, prospective, open, international, randomized trial with blinded assessment of outcomes. Patients with STEMI undergoing PPCI are randomized to upfront routine manual aspiration Thrombectomy with the Export catheter (Medtronic CardioVascular, Santa Rosa, CA) or to percutaneous coronary intervention alone. The primary outcome is the composite of cardiovascular death, recurrent myocardial infarction, cardiogenic shock, or new or worsening New York Heart Association class IV heart failure up to 180 days. The trial uses an event-driven design and will recruit 10,700 patients. Summary The TOTAL trial will determine the effect of routine manual aspiration Thrombectomy during PPCI on clinically important outcomes.
Jeffrey G Gossett - One of the best experts on this subject based on the ideXlab platform.
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superior vena cava Thrombectomy with the x sizer catheter system in a child with fontan palliation
Catheterization and Cardiovascular Interventions, 2007Co-Authors: Jeffrey G Gossett, Albert P Rocchini, Aimee K ArmstrongAbstract:A 4-year-old female with hypoplastic left heart syndrome and Fontan palliation presented with severe neurologic impairment from thrombosis of the superior vena cava (SVC). She underwent successful SVC Thrombectomy with the X-SIZER® Thrombectomy Catheter System, followed by balloon angioplasty. She demonstrated rapid improvement in her neurologic deficits after the procedure. This represents the first published use of the X-SIZER in a child and its first published use for SVC Thrombectomy. © 2006 Wiley-Liss, Inc.
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Superior vena cava Thrombectomy with the X‐SIZER® catheter system in a child with Fontan palliation
Catheterization and Cardiovascular Interventions, 2007Co-Authors: Jeffrey G Gossett, Albert P Rocchini, Aimee K ArmstrongAbstract:A 4-year-old female with hypoplastic left heart syndrome and Fontan palliation presented with severe neurologic impairment from thrombosis of the superior vena cava (SVC). She underwent successful SVC Thrombectomy with the X-SIZER® Thrombectomy Catheter System, followed by balloon angioplasty. She demonstrated rapid improvement in her neurologic deficits after the procedure. This represents the first published use of the X-SIZER in a child and its first published use for SVC Thrombectomy. © 2006 Wiley-Liss, Inc.
Gennaro Sardella - One of the best experts on this subject based on the ideXlab platform.
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clinical impact of Thrombectomy in acute st elevation myocardial infarction an individual patient data pooled analysis of 11 trials
European Heart Journal, 2009Co-Authors: Francesco Burzotta, Maria De Vita, Youlan L Gu, T Isshiki, Thierry Lefevre, Anne Kaltoft, Dariusz Dudek, Gennaro Sardella, Pedro Silva Orrego, David AntoniucciAbstract:Aims Thrombectomy in patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) is associated to better myocardial reperfusion. However, no single trial was adequately powered to asses the impact of Thrombectomy on long-term clinical outcome and to identify patients at higher benefit. Thus, we sought to assess these issues in a collaborative individual patient-data pooled analysis of randomized studies (study acronym: ATTEMPT, number of registration: NCT00766740). Methods and results Individual data of 2686 patients enrolled in 11 trials entered the pooled analysis. Primary endpoint of the study was all-cause mortality. Major adverse cardiac events (MACE) were considered as the occurrence of all-cause death and/or target lesion/vessel revascularization and/or myocardial infarction (MI). Subgroups analysis was planned according to type of Thrombectomy device (manual or non-manual), diabetic status, IIb/IIIa-inhibitor therapy, ischaemic time, infarct-related artery, pre-PCI TIMI flow. Clinical follow-up was available in 2674 (99.6%) patients at a median of 365 days. Kaplan–Meier analysis showed that allocation to Thrombectomy was associated with significantly lower all-cause mortality ( P = 0.049). Thrombectomy was also associated with significantly reduced MACE ( P = 0.011) and death + MI rate during the follow-up ( P = 0.015). Subgroups analysis showed that Thrombectomy is associated to improved survival in patients treated with IIb/IIIa-inhibitors ( P = 0.045) and that the survival benefit is confined to patients treated in manual Thrombectomy trials ( P = 0.011). Conclusion The present large pooled analysis of randomized trials suggests that Thrombectomy (in particular manual Thrombectomy) significantly improves the clinical outcome in patients with STEMI undergoing mechanical reperfusion and that its effect may be additional to that of IIb/IIIa-inhibitors.
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adjunctive manual Thrombectomy improves myocardial perfusion and mortality in patients undergoing primary percutaneous coronary intervention for st elevation myocardial infarction a meta analysis of randomized trials
European Heart Journal, 2008Co-Authors: Giuseppe De Luca, Dariusz Dudek, Gennaro Sardella, Paolo Marino, Bernard Chevalier, Felix ZijlstraAbstract:Aims The benefits of adjunctive mechanical devices to prevent distal embolization in patients with acute myocardial infarction (AMI) are still a matter of debate. Growing interests are on manual Thrombectomy devices as compared with other mechanical devices. In fact, they are inexpensive and user-friendly devices, and thus represent an attractive strategy. The aim of the current study was to perform an updated meta-analysis of randomized trials conducted with adjunctive manual Thrombectomy devices to prevent distal embolization in AMI. Methods and results The literature was scanned by formal searches of electronic databases [MEDLINE, CENTRAL, EMBASE, and The Cochrane Central Register of Controlled trials (http://www.mrw.interscience.wiley.com/cochrane/Cochrane\_clcentral\_articles_ fs.html)] from January 1990 to May 2008, the scientific session abstracts (from January 1990 to May 2008) and oral presentation and/or expert slide presentations (from January 2002 to May 2008) [on transcatheter coronary therapeutics (TCT), AHA (American Heart Association), ESC (European Society of Cardiology), ACC (American College of Cardiology) and EuroPCR websites]. We examined all randomized trials on adjunctive mechanical devices to prevent distal embolization in AMI. The following keywords were used: randomized trial, myocardial infarction, reperfusion, primary angioplasty, rescue angioplasty, Thrombectomy, thrombus aspiration, manual Thrombectomy, Diver catheter, Pronto catheter, Export catheter, thrombus vacuum aspiration catheter. Information on study design, type of device, inclusion and exclusion criteria, number of patients, and clinical outcome was extracted by two investigators. Disagreements were resolved by consensus. A total of nine trials with 2417 patients were included [1209 patients (50.0%) in the manual Thrombectomy device group and 1208 (50%) in the control group]. Adjunctive manual Thrombectomy was associated with significantly improved postprocedural TIMI (thrombolysis in myocardial infarction) 3 flow (87.1 vs. 81.2%, P < 0.0001), and postprocedural MBG 3 (myocardial blush grade 3) (52.1 vs. 31.7%, P < 0.0001), less distal embolization (7.9 vs. 19.5%, P < 0.0001), and significant benefits in terms of 30-day mortality (1.7 vs. 3.1%, P = 0.04). Conclusion This meta-analysis demonstrates that, among patients with AMI treated with percutaneous coronary intervention, the use of adjunctive manual Thrombectomy devices is associated with better epicardial and myocardial perfusion, less distal embolization and significant reduction in 30-day mortality. Thus, adjunctive manual Thrombectomy devices, if not anatomically contraindicated, should be routinely used among STEMI (ST-segment elevation myocardial infarction) patients undergoing primary angioplasty.
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impact of intracoronary aspiration Thrombectomy during primary angioplasty on left ventricular remodelling in patients with anterior st elevation myocardial infarction
Heart, 2006Co-Authors: L De Luca, Gennaro Sardella, Charles J Davidson, G De Persio, M Beraldi, T Tommasone, Massimo Mancone, Bich Lien Nguyen, Luciano Agati, Mihai GheorghiadeAbstract:Objective: To evaluate prospectively the impact on left ventricular (LV) remodelling of an intracoronary aspiration Thrombectomy device as adjunctive therapy in primary percutaneous coronary intervention (PCI) in patients with anterior ST elevation myocardial infarction (STEMI). Methods: 76 consecutive patients with anterior STEMI (65.3 (11.2) years, 48 men) were randomly assigned to intracoronary Thrombectomy and stent placement (n = 38) or to conventional stenting (n = 38) of the infarct related artery. Each patient underwent transthoracic echocardiography immediately after PCI and at six months. At the time of echocardiographic control, major adverse cardiovascular events (MACE) in terms of death, new onset of myocardial infarction, and hospitalisation for heart failure were also evaluated. Results: After a successful primary PCI, patients in the Thrombectomy group achieved a higher rate of post-procedure myocardial blush grade 3 (36.8% v 13.1%, p = 0.03) and effective ST segment resolution at 90 minutes (81.6% v 55.3%, p = 0.02). Six months after the index intervention, 19 patients (26.8%) developed LV dilatation, defined as an increase in end diastolic volume (EDV) ⩾ 20%: 15 in the conventional group and four in the Thrombectomy group (p = 0.006). Accordingly, at six months patients treated conventionally had significantly higher end systolic volumes (82 (7.7) ml v 75.3 (4.9) ml, p v 138.1 (10.7) ml, p v 8.6% in the Thrombectomy group, not significant). Conclusion: Compared with conventional stenting, adjunctive aspiration Thrombectomy in successful primary PCI seems to be associated with a significantly lower incidence of LV remodelling at six months in patients with anterior STEMI.