Comparison of Manual Thrombus Aspiration With Rheolytic Thrombectomy in Acute Myocardial Infarction

Abstract

Background-Manual thrombus aspiration (MTA) is completely ineffective in 30% of cases, and the high profiles of the catheters prevent their use in tortuous and calcified vessels. The rheolytic thrombectomy (RT) device has the potential for improved thrombus removal in acute myocardial infarction as compared with MTA. No data exist on the comparison between the 2 techniques. Methods and Results-Randomized study, including 80 acute myocardial infarction patients allocated to RT or MTA before infarct artery stenting. Primary end point of this study is residual thrombus burden by optical coherence tomography. Secondary end points are (1) residual thrombolysis in myocardial infarction thrombus grade; (2) postintervention thrombolysis in myocardial infarction flow and myocardial blush; (3) early ST-segment resolution; (4) percentage of malapposed stent struts at 6 months; (5) 6-month restenosis; and (6) 6-month major adverse cardiovascular events. All but 1 patient had residual thrombus after manual aspiration thrombectomy or RT. The number of optical coherence tomography quadrants containing thrombus in MTA arm was higher than in the RT arm, but this difference did not reach significance (median value 65 and 53, respectively; P=0.083). Large residual thrombus was more frequently revealed in the manual aspiration thrombectomy arm (patients with number of quadrants above the median value 60% in the manual aspiration thrombectomy arm and 37% in the RT arm, P=0.039). All markers of reperfusion were better in the RT arm. At 6 months, the percentage of malapposed stent struts in the MTA arm was higher than in the RT arm (2.7±4.5% and 0.8±1.6%, respectively; P=0.019). Conclusions-MTA or RT allows only incomplete removal of thrombus in patients with acute myocardial infarction. The primary end point of the study was not met. However, RT as compared with MTA seems to be more effective in thrombus removal and myocardial reperfusion.

Impact of Culprit Plaque and Atherothrombotic Components on Incomplete Stent Apposition in Patients With ST-Elevation Myocardial Infarction Treated With Everolimus-Eluting Stents – An OCTAVIA Substudy –

“…These results are consistent with OCT studies that recently assessed manual thrombectomy in patients undergoing p-PCI, where similar high rates of remaining thrombus and no substantial improvement in the mean flow area were reported after stenting with thrombus aspiration compared with stenting alone. 17, 18 Conversely, acute ISA, especially in the vessels with larger reference lumen area, was frequently observed at stent edges without any plaque in the present study. This finding suggested that acute ISA in situations in which there is difficulty in obtaining fully apposed struts can be independent of plaque morphology or residual thrombus.…”

Management of Intracoronary Thrombus

“…The AnjioJet is an example of a rheolytic system [34]. This device has lost its appeal after trials demonstrated an increased mortality with no difference in infarct size or resolution of ST segments [35,36]. Manual or 'aspiration' thrombectomy has been studied in large randomized controlled trials and emerged as the preferred method of thrombus removal primary due to its simplicity and ease of use.…”

Interventional Strategies in Thrombus Management for ST Elevation Myocardial Infarction

“…A recent optical coherence tomography (OCT) trial suggests that the Angiojet when compared to manual thrombectomy may be more effective at thrombus removal. 33 Future large-scale trials are needed to determine the effect of the modern Angiojet on clinical outcomes in the subset of patients with high thrombus burden after wire crossing.…”