Long‐term outcomes with aspiration thrombectomy for patients undergoing primary percutaneous coronary intervention: A meta‐analysis of randomized trials

Elgendy, Islam Y.; Mahmoud, Ahmed; Bavry, Anthony A.

doi:10.1002/clc.22691

Cited by 16 publications

(13 citation statements)

References 46 publications

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“…Pharmacologically facilitated PCI has been associated with significant increase in bleeding and has failed to show any improvements in the clinical outcomes [ 4 , 18 ]. Similarly, recent randomized clinical trials (RCTs) and meta-analyses showed that the routine use of aspiration thrombectomy in STEMI is not associated with any benefit [ 6 ] and is recommended only in select patients [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Balloon inflation is associated with higher risk of distal embolization and microvascular occlusion, which is associated with worse outcomes [ 5 ]. Moreover, recent randomized clinical trials and meta-analyses showed that the routine use of aspiration thrombectomy in STEMI was not associated with any benefit on short-term outcomes [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Deflated Balloon-Facilitated Direct Stenting in Primary Angioplasty (The DBDS Technique): A Pilot Study

Verma

Singh²,

Saxena³

et al. 2018

Cardiol Res

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BackgroundSeveral studies and meta-analyses have shown that direct stenting (DS) may improve clinical outcomes in patients with acute ST-elevation myocardial infarction (STEMI). But in most cases, the thrombolysis in myocardial infarction (TIMI) flow remains ≤ 1 after wire placement. We used deflated balloon to facilitate DS in patients with totally occluded culprit arteries. The aim of this study was to evaluate the feasibility, safety and outcomes of this novel technique in patients with STEMI in real-world clinical practice.MethodsThis was a prospective, observational, single-center pilot study. From September 2016 to June 2018, 454 patients were enrolled in the study. DS was performed when the culprit vessel was visualized with at least TIMI flow grade 1. Patients with complete occlusion of the vessel after wire placement were subjected to deflated balloon-facilitated DS technique (DBDS technique) and DS was done wherever possible.ResultsDS was done in 74% (n = 336) of the patients and 26% (n = 118) patients received stenting after pre-dilatation (PD). DBDS technique to facilitate DS was successful in 68% patients (211/309). Final TIMI 3 flow was achieved more frequently in the DS group as compared to PD group (96.7% versus 92.3%, P = 0.04). The procedural complications were also significantly lower in DS group (0.6% versus 7.6%, P < 0.001). DS group had significantly lower procedure time (33 ± 19 min versus 41 ± 17 min, P < 0.001), fluoroscopy time (6.2 ± 3.4 min versus 7.8 ± 32 min, P < 0.001), required lesser contrast volume (112 ± 16 mL versus 123 ± 18 mL, P < 0.001) and had lower procedural cost (310 ± 45$ versus 402 ± 56$, P < 0.001). ST-segment resolution > 50% after percutaneous coronary intervention (PCI) were significantly higher in the DS group (85.7% versus 71.1%, P < 0.001). At 30 days, the major adverse cardiac event (MACE) rate was significantly lower in the DS group (2.4% versus 9.3%, P = 0.02), mainly driven by lower rates of target lesion revascularization (TLR) (0.9% versus 4.2%, P = 0.01).ConclusionThis cost-effective technique appears to be simple, feasible and safe and is associated with superior clinical outcomes. It helps in maximizing DS and could offer an alternative to PD and aspiration thrombectomy in total occlusion. However, larger studies with longer follow up are required before a wider application of this technique.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Deflated Balloon-Facilitated Direct Stenting in Primary Angioplasty (The DBDS Technique): A Pilot Study

Verma

Singh²,

Saxena³

et al. 2018

Cardiol Res

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“…The saline solution exits the tip at approximately 500 km/h to create a circumferential zone of depression by the Bernoulli effect which crumples and aspirates thrombus (Petronio et al 2010). Rheolytic thrombectomy has since been widely adapted for percutaneous coronary intervention (PCI) and treatment for lower extremity deep vein thrombosis (Antoniucci et al 2004;Garcia et al 2015;Leung et al 2015;Elgendy et al 2017).…”

Section: Discussionmentioning

confidence: 99%

Treatment of superior vena cava syndrome using AngioJet™ thrombectomy system

et al. 2019

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Background: Superior vena cava syndrome is a relatively rare presentation in which diminished venous return to the heart produces congestion of the neck, face and upper extremities. Typically, a mediastinal mass produces external compression on the superior vena cava and reduces venous return. However, superior vena cava syndrome can present acutely in the setting of vena cava thrombosis. Multiple scoring systems are available to assist clinicians with appropriate timing of interventions for SVC syndrome. When specific criteria are met, endovascular intervention can be beneficial to patients to prevent rapid deterioration. Case presentation: A 75-year-old female with no significant past medical history presented to the emergency department with increased facial swelling, nausea and vomiting which began the night prior to presentation. The patient underwent a CT chest which revealed a 3.2 × 3.0 × 3.8 cm spiculated mass compressing the right main bronchus and right pulmonary artery. The patient was intubated and interventional radiology was consulted. The patient underwent venography which showed extensive thrombosis of the innominate veins. Rheolytic thrombectomy with AngioJet™ was performed to alleviate clot burden and minimize risk of secondary pulmonary embolism. Kissing stents were placed in the bilateral innominate veins to maintain patency after thrombectomy. After the procedure, the patient was successfully extubated and had near complete resolution of facial swelling approximately 12 h post procedure. A follow up venogram performed on post procedure day 4 showed patent bilateral subclavian, innominate, and internal jugular veins as well as a patent superior vena cava. Conclusions: Acute occlusion of superior vena cava can present with life threatening symptoms such as loss of airway. AngioJet™ thrombectomy is another tool available to interventional radiologists when a patient's clinical condition necessitates treatment.

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“…While thrombus aspiration (TA) might have a potential role in patients with STEMI and heavy thrombus burden, recent trials have reported unsatisfactory results with TA including no reduction in mortality and a possible increased risk of stroke . It is important to note, however, that many of these trials excluded STEMI patients with late presentation after the onset of symptoms, adding more to the debate regarding the role of TA in such population.…”

Section: Introductionmentioning

confidence: 99%

“…unsatisfactory results with TA including no reduction in mortality and a possible increased risk of stroke. [8][9][10] It is important to note, however, that many of these trials excluded STEMI patients with late presentation after the onset of symptoms, adding more to the debate regarding the role of TA in such population. The current study is a single-center prospective randomized study that aimed at determining the role of adjunctive routine manual TA using Diver CE catheter during PPCI in patients presenting with STEMI ≥12 and ≤48 h after symptom onset.…”

mentioning

confidence: 99%

Thrombus aspiration in late presenters with ST‐elevation myocardial infarction: A single‐center randomized trial

Rezq

Saad

2018

J Interven Cardiology

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Long‐term outcomes with aspiration thrombectomy for patients undergoing primary percutaneous coronary intervention: A meta‐analysis of randomized trials

Cited by 16 publications

References 46 publications

Deflated Balloon-Facilitated Direct Stenting in Primary Angioplasty (The DBDS Technique): A Pilot Study

Deflated Balloon-Facilitated Direct Stenting in Primary Angioplasty (The DBDS Technique): A Pilot Study

Treatment of superior vena cava syndrome using AngioJet™ thrombectomy system

Thrombus aspiration in late presenters with ST‐elevation myocardial infarction: A single‐center randomized trial

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