摘要
背景不同可行、安全的 thrombectomy 和远侧的保护设备用 Diver CE 设备在临床的 practice.The 效率和附属物 thrombectomy 的安全被使用了( Invatec ，意大利 )对 Guardwire 正设备( Medtronic ，美国)在经皮的冠的干预(一种总线标准)与尖锐劣等的 ST-segment-elevation 心肌的梗塞( STEMI )在病人被作比较不到 12 个小时以前，在心肌的梗塞( TIMI )的 thrombolysis 流动分级 0～1 ，并且总计吸藏第二等的结束点被让结束心脏舒张的体积( LVEDV )室，左室喷射部分( LVEF )和包括死亡的主要不利心脏的事件(权标)，心肌的梗塞，在 122 个病人的 30 days.Results A 总数的目标容器 revascularization 和击同等地被划分成 Diver CE 组和 Guardwire 正组，它到年龄是可比较的(( 60 ?????????汣灯摩杯敲????朠潲灵?潃据畬楳湯??湡獵?
Background Different feasible and safe thrombectomy and distal protection devices have been used in clinical practice. The efficiency and safety of adjunct thrombectomy using Diver CE device （Invatec, Italy） versus Guardwire Plus device （Medtronic, USA） before percutaneous coronary intervention （PCI） were compared in patients with acute inferior ST-segment-elevation myocardial infarction （STEMI） for less than 12 hours, thrombolysis in myocardial infarction （TIMI） flow grade 0 to 1, and total occlusion of the proximal right coronary artery （≥3 mm in diameter） in a prospective randomized single-center study.
Methods The primary end point was the magnitude of ST-segment resolution （STR） （〉70%） measured immediately, 90 minutes and 6 hours after PCI, myocardial blush grade and slow flow or no-reflow. Secondary end points were left ventricular end-diastolic volume （LVEDV）, left ventricle ejection fraction （LVEF） and major adverse cardiac events （MACEs） including death, myocardial infarction, target vessel revascularization and stroke at 30 days.
Results A total of 122 patients were equally divided into Diver CE group and Guardwire Plus group, which were comparable by age （（60±14） years vs （60±13） years）, male （82% vs 84%）, diabetes （31% vs 28%）, previous coronary artery disease （25% vs 23%）, onset-to-angiogram （（350±185） min vs （345±180） min）, and use of glycoprotein lib/llia inhibitor （11% vs 13%）. The magnitude of ST-segment resolution was similar in the two groups as ST-segment resolution 〉70% （57% vs 59%; P〉0.05）. Similar slow flow/no-reflow rates were observed in the Diver CE group （8%） and the Guardwire Plus group （7%）. TIMI flow grade 3 was obtained in 95% vs 97% patients, respectively （P〉0.05）. Myocardial blush grade 3 was similar （70% vs 72%; P〉0.05）. Thirty-day clinical outcome was comparable （LVEF, 0.54±0.12 vs 0.53 ±0.11; death, 3% vs 3%; myocardial infarction, 2% vs 0%; and target vessel revascularization, 2% vs 2%; P〉0.05, respectively）.
Conclusions Removal of thrombus burden with the Diver CE catheter before stenting leads to similar improvement of myocardial reperfusion in patients with inferior STEMI and total occlusion of the proximal right coronary artery （≥3 mm in diameter） compared with the Guardwire Plus device, as illustrated by a reduced risk of distal embolization and improved ST-segment resolution.
