Abstract:

Immediate and long-term results of pharmacologically "facilitated" percutaneous coronary inter-ventions (PCI) evaluated in 172 patients with myocardial infarction (MI). Pharmacological reperfusion tried prior to PCA with thrombolytic therapy (TLT, streptokinase or tenecteplase) in 81% of patients, and combination TLT + glycoprotein IIb/IIIa inhibitors (abciximab) in 19%. Average symptom onset to reperfusion time was 197±103 min.

Immediately after PCI 88% patients in both groups presented TIMI - 3 flow (р<0.01 to the initial). Repeated PCI during the hospital stay performed in 4 patients (3 in TLT group, 1 in TLT + abciximab group) with recurrent ischemia or subacute vessel occlusion as a cause of intervention. CABG needed in 2 cases. In-hospital survival rate after 'facilitated' PCI was 98,6 - 100%. 6 months clinical follow-up done in 67% of survivors, 16% of them required admission to hospital (recurrent angina due to restenosis), in 9% patients repeated PCI was performed, 6% underwent coronary bypass grafting. All the repeated procedures were success. Overall 6 months mortality was 5%. This prospective study has shown both immediate and long-term safety and efficiency of "facilitated" coronary interventions in patients with myocardial infarction.

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Abstract:

We present the clinical case of the effective and safe application of the «Filterwire EZ» embolic protection device (Boston Scientific, USA) for prevention of «no-reflow» phenomenon during primary percutaneous coronary angioplasty in a patient with acute myocardial infarction.

During performing of balloon angioplasty of infarct-related segment of the circumflex left coronary artery with the protection of the distal segments of artery by «Filterwire EZ» device the embolic event was observed. After the final stent implantation the thrombus was removed by embolic protection device, size of the thrombus - 3x4 mm. Control coronarography confirmed the TIMI 3 blood flow in the infarct-related coronary artery.

Presence of different types of devices for capturing or removing of thrombotic masses in the arsenal of interventional cardiologist can improve the results of primary percutaneous coronary angioplasty in patients with acute myocardial infarction. 

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