OBJECTIVES: We describe our initial clinical experience with a new catheter system designed to mechanically disrupt and remove intravascular thrombus in patients with myocardial infarction.

BACKGROUND: The presence of intra-coronary thrombus remains problematic during percutaneous coronary intervention. The Rinspiration^® system (Kerberos Proximal Solutions Inc., Sunnyvale, CA) consists of two components; a rinsing catheter and manual activator. The system allows for simultaneous irrigation and aspiration of the clot from the treatment site.

METHODS: “Rinspiration” was performed in 15 patients with angiographically visible thrombus in native coronaries (10 cases) and in saphenous grafts (5 cases). Indications included acute myocardial infarction in 11 cases, post-infarction ischemia in 4 cases. Independent core angiographic analysis results are presented as median with interquartile range (IQR).

RESULTS: The Rinspiration system appeared safe and reasonably intuitive to use. There were no device-related complications. The catheter was successful in reducing thrombus load. Thrombus grade improved from 4.0 (IQR 4,5) to 3.0 (IQR 1,4) although TIMI flow did not change significantly, being 2.0 (IQR 0,3) beforehand and 2.0 (IQR 2,3) after thrombectomy. Analysis of the aspirated fluid demonstrated recovery of matter ranging from particulate debris to visible thrombus. Final results revealed thrombus grade of 0.0 (IQR 0,1), TIMI flow of 3.0 (IQR 3,3) and myocardial blush score of 3 (IQR 2,3). At 30-day follow up all patients remained free of repeat revascularization and re-infarction; 1 patient died from hemorrhagic stroke.

CONCLUSION: We have demonstrated the feasibility of intra-coronary rheolytic thrombectomy using Rinspiration^® system. A multi-center study is underway.

DNC

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