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目的 AngioJet流体溶血栓吸引术是通过流体击碎并吸引冠状动脉内血栓而将其移出体外的一种新的冠状动脉介入治疗技术。本研究以TIMI心肌灌注级别作为疗效指标评价该技术对急性心肌梗死血栓性病变的疗效。方法 选择澳大利亚皇家珀斯医院 2 0 0 0年 1月至 2 0 0 1年 1月所有冠状动脉造影明确显示血栓性病变的急性心肌梗死患者共 2 8例作为研究对象。其中 1 3例患者于支架置入术前进行了AngioJet流体溶血栓吸引术 (AngioJet组 ) ,而另 1 5例患者只行直接支架置入术(支架组 )。重点比较两组患者之间治疗前后心表面冠状动脉TIMI血流及TIMI心肌灌注级别 (后者与预后有强烈的相关性 )的变化。结果 支架组术后心表面冠状动脉TIMI血流及TIMI心肌灌注级别均明显优于AngioJet组 (分别为 2 60± 0 0 9vs 2 2 3± 0 1 6 ,P =0 0 4 2及 2 50± 0 1 1vs 1 92± 0 2 3 ,P=0 0 2 4 )。AngioJet组冠状动脉穿孔的例数显著多于支架组 (分别为 3例及 0例 ,P =0 0 4 9)。结论对于急性心肌梗死血栓性病变 ,支架置入术治疗可获得良好疗效 ;支架置入前采用AngioJet流体溶血栓吸引术并不增加疗效 ,甚至可能存在潜在的不良作用
Purpose AngioJet fluid thrombolytic aspiration is a novel coronary interventional technique that removes fluid from the body by fluid-crushed and occluded thrombus in the coronary artery. In this study, TIMI myocardial perfusion level as a measure of efficacy of this technology for the treatment of thrombotic lesions in patients with acute myocardial infarction. Methods A total of 28 acute myocardial infarction patients with coronary arteriography clearly showing thrombotic lesions from January 2007 to January 2001 in Royal Perth Hospital in Australia were selected as the study subjects. Thirteen of these patients underwent AngioJet fluid thrombolysis (AngioJet group) before stenting, while the other 15 patients underwent direct stenting (stent group). The changes of TIMI flow in the coronary arteries and TIMI myocardial perfusion level (the latter had a strong correlation with the prognosis) were compared between the two groups. Results The myocardial TIMI flow and TIMI myocardial perfusion were significantly better in the stent group than those in the AngioJet group (2 60 ± 0 0 9 vs 2 2 3 ± 0 1 6, P 0 042 and 2 50 ± 0 1 1 vs 1 92 ± 0 2 3, P = 0 0 2 4). There were significantly more cases of coronary perforation in the AngioJet group than in the stent group (3 and 0, respectively, P = 0 049). Conclusion For the treatment of thrombotic events of acute myocardial infarction, stent implantation can achieve good results. AngioJet fluid thrombectomy before stent insertion does not increase the efficacy and may even have potential adverse effects