Lefèvre T et al. (2005) X-Sizer for thrombectomy in acute myocardial infarction improves ST-segment resolution. J Am Coll Cardiol 46: 246–252

Percutaneous coronary intervention (PCI) with stenting is the conventional method for treating acute myocardial infarction and can restore normal epicardial flow. Optimal myocardial tissue reperfusion can be limited by thrombus and plaque embolization during PCI. Few studies have tested the safety and efficacy of mechanical devices for thrombectomy before PCI, leading Lefèvre et al. to conduct a prospective, randomized, multicenter trial to assess performance of the X-Sizer® device (EndiCOR Medical Inc., San Clemente, CA, USA). Patients with acute myocardial infarction within the previous 12 h underwent either thrombectomy before PCI with stenting (n = 100) or PCI with stenting alone (n = 101). The magnitude of increase in ST-segment resolution before and 1 h after treatment was used as a marker for myocardial reperfusion and the primary end point.

In 87% of patients, the X-Sizer® device removed the thrombus either completely or partially. At 1 month and 6 months' follow-up, there was no significant difference in MYOCARDIAL BLUSH grade or incidence of major adverse cardiac and cerebral events between the two treatment groups, but ST-segment resolution was greater in patients who underwent thrombectomy (8.5 ± 10.1 mm versus 6.8 ± 9.3 mm; P = 0.003) and the risk of distal embolization was reduced (2.1% versus 10%; P = 0.033). No serious device-related adverse effects were reported.

In conclusion, thrombectomy with the X-Sizer® prior to PCI can improve myocardial reperfusion in acute myocardial infarction patients. Larger clinical trials are needed to assess long-term clinical outcomes and alternative mechanical or pharmacologic treatments.