We have developed a mechanical thrombolytic catheter which defibrinates a fresh intra-arterial thrombus by wrapping fibrin about its rotating shaft. Defibrination results in liquification of the thrombus and reperfusion of the thrombotically occluded vessel. In this study, we employed this catheter-based approach in dogs with coronary thrombosis to simulate possible clinical use in acute myocardial infarction. Total coronary thrombosis was generated in 11 dogs. Spontaneous reperfusion did not occur over a 30-minute control period. All vessels studied were initially totally thrombosed. After mechanical thrombolysis, there was a significant improvement in percent diameter stenosis from 100% to 28 +/- 26% (P less than 0.001). After thrombolysis, angiographically graded blood flow was normal in 9 of 11 arteries and was mildly delayed in 2 of 11. Complications included perforation of 2 vessels. We conclude that mechanical thrombolysis, with a rotating catheter, results in prompt reperfusion of the infarct vessel and significant improvement in distal blood flow. This approach, unlike angioplasty, removes the thrombus and might serve as an alternative to or supplemental form of mechanical thrombolysis.
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