Preliminary experiences using X-sizer catheter for mechanical thrombectomy of thrombus-containing lesions during acute coronary syndromes

Thrombus-containing lesions are frequently observed in patients with acute coronary syndromes. These lesions are prone to increased procedural risks, including distal embolization and abrupt closure of the vessel. This preliminary report evaluates if thrombus removal using a new X-Sizer catheter could reduce thrombotic burden and optimize angioplasty results. Thrombectomy was attempted with the X-Sizer catheter in 11 patients (age, 59 ± 10 years) undergoing coronary angioplasty with angiographic evidence of intracoronary thrombus. The device uses a helix cutter contained in a 4.5 or 5.5 Fr catheter tip connected to a closed vacuum aspiration system. Procedural outcomes using detailed angiographic analysis and clinical data were obtained from all treated patients. Seven patients (64%) had acute or recent myocardial infarction and four patients (36%) presented with unstable angina. The culprit lesion was located in right coronary, left anterior, vein graft, and circumflex-marginal in five, three, two, and one patient, respectively. The mean proximal reference diameter was 3.37 ± 0.39 mm and % diameter stenosis was 90% ± 15% prior to thrombectomy and decreased to 72% ± 16% afterward and was 9% ± 10% at the end of the procedure. The TIMI flow increased from 0.8 ± 1.0 to 2.1 ± 0.9 following thrombectomy and the final TIMI grade was 2.9 ± 0.3. Stents were used in 9 of 11 patients. Procedural success was achieved in 10 of 11 patients (91%). No evidence of stent thrombosis was noted among treated patients in hospital and at 30-day follow-up. In this preliminary series of patients with angiographic evidence of thrombus, the use of X-Sizer thrombectomy seems to be feasible and relatively safe, permitting thrombus removal and improved intracoronary flow.