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Background Different feasible and safe thrombectomy and distal protection devices have been used in clinical practice.The efficiency and safety of adjunct thrombectomy using Diver CE device(Invatec,Italy)versus Guardwire Plus device(Medtronic,USA)before percutaneous coronary intervention(PCI)were compared in patients with acute inferiorST-segment-elevation myocardial infarction(STEMI)for less than 12 hours,thromboiysis in myocardial infarction(TIMI)flow grade 0 to 1,and total occlusion of the proximal right coronary artery(≥3 mm in diameter)in a prospectiverandomized single-center study.Methods The primary end point was the magnitude of ST-segment resolution(STR)(>70%)measured immediately,90minutes and 6 hours after PCI,myocardial blush grade and slow flow or no-reflow.Secondary end points were leftventricular end-diastolic volume(LVEDV),left ventricle ejection fraction(LVEF)and major adverse cardiac events(MACEs)including death,myocardial infarction,target vessel revascularization and stroke at 30 days.Results A total of 122 patients were equally divided into Diver CE group and Guardwire Plus group,which werecomparable by age((60±14)years vs(60±13)years),male(82% vs 84%),diabetes(31% vs 28%),previous coronaryartery disease(25% vs 23%),onset-to-angiogram((350±185)min vs(345±180)min),and use of glycoprotein Ⅱb/Ⅲainhibitor(11% vs 13%).The magnitude of ST-segment resolution was similar in the two groups as ST-segment resolution>70%(57% vs 59%;P>0.05).Similar slow flow/no-reflow rates were observed in the Diver CE group(8%)and theGuardwire Plus group(7%).TIMI flow grade 3 was obtained in 95% vs 97% patients,respectively(P>0.05).Myocardialblush grade 3 was similar(70% vs 72%;P>0.05).Thirty-day clinical outcome was comparable(LVEF,0.54±0.12 vs 0.53±0.11;death,3% vs 3%;myocardial infarction,2% vs 0%;and target vessel revascularization,2% vs 2%;P>0.05,respectively).Conclusions Removal of thrombus burden with the Diver CE catheter before stenting leads to similar improvement ofmyocardial reperfusion in patients with inferior STEMI and total occlusion of the proximal right coronary artery(≥3 mm indiameter)compared with the Guardwire Plus device,as illustrated by a reduced risk of distal embolization and improvedST-segment resolution.
Background Different feasible and safe thrombectomy and distal protection devices have been used in clinical practice. The efficiency and safety of adjunct thrombectomy using Diver CE device (Invatec, Italy) versus Guardwire Plus device (Medtronic, USA) before percutaneous coronary intervention (PCI) were compared in patients with acute inferior ST-segment-elevation myocardial infarction (STEMI) for less than 12 hours, thromboiysis in myocardial infarction (TIMI) flow grade 0 to 1, and total occlusion of the proximal right coronary artery (≥3 mm in diameter) in a prospectiverandomized single-center study. Methods The primary end point was the magnitude of ST-segment resolution (STR) (> 70%) measured immediately, 90 minutes and 6 hours after PCI, myocardial blush grade and slow flow or no- reflow. Secondary end points were left ventricular end-diastolic volume (LVEDV), left ventricle ejection fraction (LVEF) and major adverse cardiac events (MACEs) including death, myocardial infarction, target vessel revascularization a nd stroke at 30 days. Results A total of 122 patients were equally divided into Diver CE group and Guardwire Plus group, which were comparable by age ((60 ± 14) years vs (60 ± 13) years), male (82% vs 84 early coronary artery disease (25% vs 23%), onset-angiogram ((350 ± 185) min vs (345 ± 180) min), and use of glycoprotein IIb / The magnitude of ST-segment resolution was similar in the two groups as ST-segment resolution> 70% (57% vs 59%; P> 0.05). Similar slow flow / no-reflow rates were observed in the Diver CE group (8%) and the Guardwire Plus group (7%). TIMI flow grade 3 was obtained in 95% vs 97% of patients, respectively (P> 0.05) 72%; P> 0.05) .Thirty-day clinical outcome was comparable (LVEF, 0.54 ± 0.12 vs 0.53 ± 0.11; death, 3% vs 3%; myocardial infarction, 2% vs 0%; and target vessel revascularization, 2% vs 2%; P> 0.05, respectively) .Conclusions Removal of thrombus burden with the Diver CE catheter before stenting leads improvement of myocardial reperfusion in patients with inferior STEMI and total occlusion of the proximal right coronary artery (> 3 mm indiameter) compared with the Guardwire Plus device, as illustrated by a reduced risk of distal embolization and improved ST-segment resolution.