МАНУАЛЬНАЯ ТРОМБОЭКСТРАКЦИЯ У БОЛЬНЫХ С ОСТРЫМ ИНФАРКТОМ МИОКАРДА С ПОДЪЕМОМ СЕГМЕНТА ST

Дистальная эмболия коронарных артерий (ДЭКА) — серьезное осложнение чрескожного коронарного вмешательства (ЧКВ). Дистальная эмболия приводит к заметному снижению перфузии миокарда, вплоть до полного ее отсутствия, несмотря на восстановление кровотока в окклюзированном сегменте инфарктсвязанной артерии. Частота развития дистальной эмболии при ЧКВ, по разным данным, составляет около 25%. Для выявления дистальной эмболии разработаны различные методики, как инвазивные, так и неинвазивные. С целью предотвращения ДЭКА во время ЧКВ существуют разные устройства. Наиболее зарекомендованные – это устройства для тромбоэкстракции. Их можно разделить на мануальные и реолитические. Реолитические тромбоэкстракторы (с наличием механизированной части) не показали преимуществ по сравнению с обычным ЧКВ. Другое важное направление — мануальная тромбоэкстракция. Все устройства для мануальной тромбоэкстракции схожи по строению, но различаются материалом, кончиком, а также диаметром просвета. Крупные исследования по мануальной тромбоэкстракции не показали преимуществ этого устройства перед стандартным ЧКВ. Однако в настоящее время еще остается ряд вопросов по эффективности тромбоэкстракции. 

1. Erbel R, Heusch G. Brief review: coronary microembolization. J Am Coll Cardiol, 2000, 36: 22-4.

2. Самко А.Н., Меркулов Е.В. Применение ЧКВ при ОКС с подъемом сегмента ST. Болезни сердца и сосудов, 2009, 1: 34-40.

3. Heusch G, Schulz R, Haude M et al. Coronary microembolization. J Mol Cell Cardiol, 2004, 37: 23-31.

4. Saber RS, Edwards WD, Bailey KR et al. Coronary embolization after balloon angioplasty or thrombolytic therapy: an autopsy study of 32 cases. Am Coll Cardiol, 1993, 22: 1283-8.

5. Davies MJ, Thomas AC. Plaque Assuring: the cause of acute myocardial infarction, sudden ischemic death, and crescendo angina. Br Heart J, 1985, 53: 363-73.

6. Herrmann J. Periprocedural myocardial injury: 2005 update. Eur Heart J, 2005, 26: 2493-519.

7. Rogers C., Huynh R., Seifert P.A., et al. Embolic protection with filtering or occlusion balloons during saphenous vein graft stenting retrieves identical volumes and sizes of particulate debris. Circulation, 2004, 109: 1735-40.

8. Brosh D, Assali AR, Mager A. Effect of no-reflow during primary percutaneous coronary intervention for acute myocardial infarction on six month mortality. Am J Cardiol, 2007, 99: 442-445.

9. Schro..der R. Prognostic impact of early ST-segment resolution in acute ST-elevation myocardial infarction. Circulation, 2004, 110: e506-e510.

10. Ricciardi MJ, Wu E, Davidson CJ et al. Visualization of discrete microinfarction after percutaneous coronary intervention associated with mild creatine kinase-MB elevation. Circulation, 2001, 103: 2780-3.

11. Schofer J, Montz R, Mathey DG. Scintigraphic evidence of the “no reflow” phenomenon in human beings after coronary thrombolysis. Am Coll Cardiol, 1985, 5: 593-8.

12. Good CW, Blankenship JC, Scott TD et al. Feasibility and safety of ad hoc percutaneous coronary intervention in the modern era. Invasive Cardiol, 2009, 21: 194-200.

13. Antman EA, Cohen M, Bernink P et al.The TIMI Risk Score for Unstable Angina/Non-ST Elevation MI. JAMA, 2000, 284: 835-842.

14. Steigen TK, Claudio C, Abbott D et al. Angiographic core laboratory reproducibility analyses: implications for planning clinical trials using coronary angiography and left ventriculography end-points. Int J Cardiovasc Imaging, 2008, 24: 453-62.

15. Van’t Hof et al. Lancet, 1997, 350: 615.

16. Gibson CM, Cannon CP, Daley WL et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation, 1996, 93: 879-88.

17. Van’t Hof AW, Liem A, Suryapranata H et al. Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction: Myocardial blush grade. Zwolle Myocardial Infarction Study Group. Circulation, 1998, 97: 2302-6.

18. Gregg W, Abizaid A, Silber S et al. Prospective, Randomized, Multicenter Evaluation of a Polyethylene Terephthalate Micronet Mesh-Covered Stent (MGuard) in ST-Segment Elevation Myocardial Infarction : The MASTER Trial. Journal of the American College of Cardiology, 2012, 6 November, 60(Issue 19): 1975-1984.

19. LaBlanche JM, Fourrier JL, Gommeaux A et al. Percutaneous aspiration of coronary thrombus. Catheterization and cardiovascular diagnosis, 1989, 17(2): 97-8.

20. Ali A, Cox D, Dib N et al. AIMI Investigators. Rheolytic thrombectomy with percutaneous coronary intervention for infarct size reduction in acute myocardial infarction: 30-day results from a multicenter randomized study. J Am Coll Cardiol, 2006, 48: 244-252.

21. Serruys PW. Six-month results of randomized study to assess the effect of thrombus aspiration on flow area in STEMI patients: An optical frequency domain imaging study (TROFI). Presented at: EuroPCR, May 16, 2012, Paris, France.

22. Serruys PW. Six-month results of randomized study to assess the effect of thrombus aspiration on flow area in STEMI patients: An optical frequency domain imaging study (TROFI). Presented at: EuroPCR, May 16, 2012, Paris, France.

23. Burzotta F, Trani C, Romagnoli E et al. Manual thrombus-aspiration improves myocardial reperfusion: the randomized evaluation of the effect of mechanical reduction of distal embolization by thrombus-aspiration in primary and rescue angioplasty (REMEDIA) trial. J Am Coll Cardiol, 2005, 46: 371-6.

24. Dudek D, Mielecki W, Burzotta F et al. Thrombus aspiration followed by direct stenting: a novel strategy of primary percutaneous coronary intervention in STsegment elevation myocardial infarction. Results of the Polish-Italian-Hungarian RAndomized ThrombEctomy Trial (PIHRATE Trial). Am Heart J, 2010, 160: 966-72.

25. Chevalier B, Gilard M, Lang I et al. Systematic primary aspiration in acute myocardial percutaneous intervention: a multicentre randomised controlled trial of the export aspiration catheter. Euro Intervention, 2008, 4: 222-8.

26. Sardella G, Mancone M, Bucciarelli-Ducci C et al. Thrombus aspiration during primary percutaneous coronary intervention improves myocardial reperfusion and reduces infarct size: the EXPIRA (thrombectomy with export catheter in infarctrelated artery during primary percutaneous coronary intervention) prospective, randomized trial. Am Coll Cardiol, 2009, 53: 309-15.

27. Svilaas T, Vlaar PJ, van der Horst IC et al. Thrombus aspiration during primary percutaneous coronary intervention. N Engl J Med, 2008, 358: 557-67.

28. Vlaar PJ, Svilaas T, van der Horst IC et al. Cardiac death and rcinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1-year follow-up study. Lancet, 2008, 371: 1915-20.

29. De Luca L, Sardella G, Davidson CJ et al. Impact of intracoronary aspiration thrombectomy during primary angioplasty on left ventricular remodelling in patients with anterior ST elevation myocardial infarction. Heart, 2006, 92: 951-957. https://doi.org/10.1136/hrt.2005.074716.

30. Francesco Burzotta1, Maria De Vita1, Youlan L Gu et al. Clinical impact of thrombectomy in acute STelevation myocardial infarction: an individual patient-data pooled analysis of 11 trials. European Heart Journal, 2009, 30: 2193-2203. https://doi.org/10.1093/eurheartj/ehp348.

31. Windecker S, Kolh P, Alfonso F et al. 2014 ESC/EACTS Guidelines on myocardial revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal 2014. https://doi.org/10.1093/eurheartj/ ehu278.

32. Frо..bert O, Lagerqvist B, Gо..ran K et al. Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction. N Engl J Med, 2013, 369: 1587-97.

33. Lagerqvist B, Frо..bert O, Gо..ran K et al. Outcomes 1 Year after Thrombus Aspiration for Myocardial Infarction. N Engl J Med, 2014, 371: 1111-1120.

34. O'Gara PT, Kushner FG, Ascheim DD et al. 2013 ACCF/AHA Guideline for the Management of STElevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2013, 61(4): e78-e140.

35. Jolly SS, Cairns JA, Yusuf S et al. TOTAL Investigators. Randomized Trial of Primary PCI with or without Routine Manual Thrombectomy. N Engl J Med, 2015, 372: 1389-98.

36. Levine GN, Bates ER, Blankenship JC et al. 2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. J Am Coll Cardiol, 2016, 67(10): 1235-1250.