Application Of Mechanical Thrombectomy By Solitaire Device In STEMI With High Thrombus Burden

Background: Cardiovascular disease is a serious threat to human health and kills more people each year than cancer and chronic respiratory diseases combined.Acute Myocardial Infarction(AMI)is one of the most serious cardiovascular diseases.Its basic pathological changes are severe coronary artery stenosis even total occlusion.Direct percutaneous coronary intervention(PPCI)is the optimal treatment for AMI,which can directly and rapidly restore the blood flow in the diseased lumen with catheters to the coronary artery,saving the infarcted myocardium.Despite the high rate of success PPCI,there are still some patients with high thrombus burden who cannot recover effective blood perfusion after procedure.Phenomena such as no or slow reflow or distal embolism limit the benefit of PPCI and reduce the prognosis of patients.So far,a large number of studies have proved that high thrombus burden of infarction-related artery(IRA)is an important factor affecting the poor prognosis of patients with acute myocardial infarction.High coronary thrombus burden in AMI patients is the biggest obstacle to the recovery of effective myocardial perfusion after PCI.Objective:In this study,patients with high thrombus burden after failed thrombus aspiration were selected as subjects.By analyzing MACE events during 1-year follow-up during hospitalization,the efficacy and safety of thrombectomy by Solitaire were investigated.Methods:16 patients with high thrombus burden were enrolled who got admitted to Jilin university during January 2017 and July 2019.They were assigned to Solitaire group and control group according to willingness of acceptting thrombectomy by Solitarie device.Analysis differences of rate of MACE during hospitalization and 1year follow-up between the two groups.Results:1.In the Solitaire group,all patients’ TIMI blood flow grades after procedure was restored to level 3.No distal embolism was found in CAG,and no mechanical complications related to thrombectomy were found.2.During hospitalization,1 case of acute respiratory failure occurred in the Solitaire group,and no all-cause death,mechanical complications,recurrent myocardial infarction or MACE occurred,which was lower than that of the control group(0 vs.37.5%,P > 0.05).0 vs.25%,P > 0.05;0 vs.25%,P < 0.05;0 vs.62.5%,P < 0.05).3.During follow-up,the mortality rate of Solitaire group was significantly lower than that of the control group(log-rank test P=0.035),and the incidence of MACE events was significantly lower than that of the control group(log-rank test,P=0.016).Conclusion:For STEMI patients with high thrombus burden,thrombectomy by Solitaire stent can effectively reduce the thrombus burden,the incidence of recent and long-term rate of MACE,without increased incidence of procedure related complications.