Efficacy of Long Inflation Balloon Angioplasty for Acute Myocardial Infarction Due to Thrombotic Lesions

Abstract

Background: Distal embolism is a frequent complication in percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) due to thrombotic lesions. Distal embolism causes no reflow phenomenon, which leads to worse patient prognosis after AMI. There is no established treatment to prevent distal embolism in PCI for thrombotic lesions. The aim of this study is to investigate the usefulness of long inflation balloon angioplasty (LIBA) with perfusion balloon in PCI for AMI due to thrombotic lesions.

Methods and results: This is a case series study. We investigated 10 cases treated with LIBA for cases with massive thrombus remaining after thrombus aspiration therapy in primary PCI for acute myocardial infarction. We investigated the success rate of the procedure, residual stenosis rate, TIMI flow grade, TIMI frame count, and myocardial blush score in 10 cases of primary PCI with LIBA at our hospital. In all 10 cases, distal embolism was not observed by angiogram after LIBA. In 9 cases, residual stenosis was improved to less than 25% and the procedure was completed without a stent. Before PCI, all cases had TIMI flow grade 0, but in all 10 cases, TIMI flow grade 3 was obtained after PCI. The mean TIMI frame count was 19.6 ± 2.50 for RCA lesions and 27.5 ± 1.5 for LAD lesions. Regarding myocardial blush score, grade 3 was obtained in 8 cases and grade 2 was obtained in 2 cases.

Conclusion: LIBA using a perfusion balloon is a useful technique in thrombus lesion to prevent distal embolism.

Keywords: Acute coronary syndrome; Long inflation balloon angioplasty; Perfusion balloon; Ryusei; Thrombus lesion.