الفهرس 
Anatomy of coronary arteriesOnly 14 pages are availabe for public view
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Abstract
Thrombus aspiration is an effective adjunctive therapy to prevent distal embolization during percutaneous coronary intervention (PCI) in patients having visible thrombus in their coronary angiography. In some patients, thrombus aspiration results in complete restoration of flow without significant residual stenosis or plaque rupture at the site of occlusion.
The goal of this study was to evaluate a strategy of thrombus aspiration during percutaneous coronary intervention (PCI) in patients with ACS having visible thrombus in their coronary angiography (30 patients) compared with conventional PCI (30 patients)
The aim of the study was to compare between the short term-outcome of thrombectomy (by Diver ce thrombus aspiration catheter) and Tirofiban versus Tirofiban alone in patients undergoing PCI for thrombus containing lesion in the setting of ACS.
60 patients with acute coronary syndromes {ST segment elevation myocardial infarction, non ST-segment elevation myocardial infarction and unstable angina} with angiographically visible thrombus constituted the study.
After history taking and physical examination all patients were subjected for ECG, full labs., echocardiography, and conventional medical therapy with upstream tirofiban infusion.
Then patients were randomized and divided into two groups:
1st group: 30 patients managed by upstream Tirofiban followed by coronary angiography and PCI using the thrombus aspiration catheter (Diver Ce) + OR - stenting.
2nd group: another 30 patients managed by upstream Tirofiban followed by coronary angiography & stenting
Then patients were evaluated for the following end points:
TIMI flow, myocardial blush grade, angiographically visible embolization, any other complication, in hospital acute & sub-acute thrombosis, in hospital bleeding, MACE. Adverse cardiac events at one month.
On comparing 30 patients in each group having the same circumstances and almost the same percentage of risk factors, it was found that manual thrombus aspiration results in improved myocardial reperfusion as documented by improvements in TIMI flow, myocardial blush grade, and clinical outcome as compared with conventional PCI as distal embolization occurred in 6 patients (20%) in group 1 while in group 2 it occurred in 15 patients (50%)
Conclusion and Recommendations
• In patients presenting with ACS with thrombus containing lesions the use of thrombus aspiration device prior to PCI seems to be a safe and effective regimen to improve the angiographic and clinical outcome in comparison to the conventional method.
• Don’t even rush in fixing a stent in 1ry PCI of a thrombus containing vessel as you may change your opinion about the size or the diameter of the stent after aspiration.
• In thrombus containing lesions , no need to hurry for total correction & achievement of TIMI III flow is sufficient in the 1st setting.
• Thromberctomy devices have solved the problem of for contraindications thrombolytics (eg.elderly ,bleeding...).
•longer period clinical follow up (6 months and one year follow up) and with large number of patients are recommended.