METHOD OF PERFORMING ASPIRATION THROMBOEMBOLECTOMY WITH GUIDING CATHETER IN PATIENTS WITH ACUTE CORONARY SYNDROME Russian patent published in 2023 - IPC A61B17/00 A61B17/22 A61M25/01 A61M25/10 

FIELD: practical medicine — cardiology; cardiovascular; x-ray endovascular surgery.

SUBSTANCE: invention can be used during percutaneous coronary intervention (PCI) for massive thrombosis of the coronary arteries or coronary artery bypass grafts in patients with acute coronary syndrome (ACS) when traditional methods of thromboembolectomy with a standard aspiration catheter are either impossible or ineffective. The following is proposed: a method of performing aspiration thromboembolectomy with a guide catheter in patients with acute coronary syndrome includes catheterization of the mouth of a target vessel, which is a coronary artery or coronary artery bypass, with a guide catheter, insertion of a coronary guide into the distal parts of the target vessel under fluoroscopy control, performing mechanical manual aspiration thromboembolectomy of an unconnected intravascular substrate from the target vessel using a negative pressure suction syringe under fluoroscopic guidance. To catheterize the mouth of the target vessel, a 5F guide catheter with a diameter of ≈ 1.67 mm or a 6F with a diameter of ≈ 2 mm is used. A coronary guidewire of 0.014"180 cm or 0.014"190 cm is inserted into the distal parts of the target vessel under fluoroscopy control. A balloon catheter with a size of 1:1 to the diameter of the target vessel is inserted along the coronary guidewire beyond the site of massive thrombosis under fluoroscopy control. Using the “anchor balloon” technique, under fluoroscopic control, deep intubation is performed with a guiding catheter at the site of massive thrombosis, twisting the catheter clockwise. The balloon catheter and coronary guidewire are removed from the target vessel. A 20–60 ml negative pressure aspiration syringe is directly connected to the guiding catheter. With constant aspiration, under fluoroscopy control, traction of the guiding catheter is performed towards itself, twisting the catheter counterclockwise, to the proximal segment of the target vessel, free from thrombosis. The negative pressure syringe filled with thrombotic masses is removed and the syringe with a volume of 10 ml is additionally filled with blood and residual fragments of thrombotic masses from the lumen of the guiding catheter. Under fluoroscopy control, a guiding catheter is brought to the mouth of the target vessel without leading into the aorta, and control angiography is performed.

EFFECT: implementation of successful aspiration thromboembolectomy for massive thrombosis of the coronary arteries or coronary artery bypass grafts which includes the removal of unbound intravascular substrate, restoration of TIMI II–III blood flow through the target vessel, the absence of hemodynamically significant distal embolization and intraoperative complications associated with the use of the method.

1 cl, 10 dwg