Outcomes after thrombus aspiration for ST elevation myocardial infarction: 1-year follow-up of the prospective randomised TOTAL trial

Jolly, Sanjit S.; Cairns, John A.; Yusuf, Salim; Rokoss, Michael; Gao, Peggy; Meeks, Brandi; Kedev, Saško; Stanković, Goran; Moreno, Raúl; Gershlick, Anthony; Chowdhary, Saqib; Lavi, Shahar; Niemelä, Kari; Bernát, Ivo; Cantor, Warren J.; Cheema, Asim N.; Steg, Philippe Gabriel; Welsh, Robert C.; Sheth, Tej; Bertrand, Olivier; Avezum, Álvaro; Bhindi, Ravinay; Natarajan, Madhu K.; Hořák, David; Leung, Raymond; Kassam, S.A.; Rao, Sunil V.; El–Omar, Magdi; Mehta, Shamir R.; Velianou, James L.; Pancholy, Samir; Džavík, Vladimir

doi:10.1016/s0140-6736(15)00448-1

Cited by 186 publications

(142 citation statements)

References 28 publications

(25 reference statements)

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“…Mechanistically, the postulated benefits of aspiration thrombectomy were less distal embolization and prevention of reperfusion injury. However, the large randomized TOTAL trial did not show any benefit for use of routine thrombectomy, and of concern there was a signal for harm with increased risk of stroke in the thrombectomy arm of the study [39][40][41]. The mechanism of stroke is likely due to aspiration back of clot and subsequent embolization to the brain.…”

Section: Thrombectomy Systemsmentioning

confidence: 99%

Management of Intracoronary Thrombus

Sathananthan

Watson²,

Overgaard

et al. 2018

Primary Angioplasty

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Partial or complete occlusion of the infarct-related artery (IRA) with intracoronary thrombus (ICT) is the pathognomonic hallmark of patients presenting with ST-elevation myocardial infarction (STEMI). Thrombus burden can be highly variable, but its presence is associated with worse outcomes, including lower procedural success, increased abrupt vessel closure and an increased frequency of major inhospital complications including death and recurrent myocardial infarction (MI). ICT poses a unique series of challenges, but appropriate management is an essential prerequisite for successful primary percutaneous coronary intervention (PPCI). This can largely be achieved using a combination of pharmacological and mechanical approaches prior to coronary stent insertion.In this chapter, we discuss the causes, sequelae and treatment of intracoronary thrombus specific to patients presenting with STEMI.

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Section: Thrombectomy Systemsmentioning

confidence: 99%

Management of Intracoronary Thrombus

Sathananthan

Watson²,

Overgaard

et al. 2018

Primary Angioplasty

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“…Nevertheless, two recent trials, the Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia (TASTE) trial and the 'The Trial of Routine Aspiration Thrombectomy with PCI versus PCI Alone in Patients with STEMI (TOTAL)' [41][42][43][44], showed no benefits in terms of clinical outcomes of thrombus aspiration during primary PCI, despite manual thrombectomy was associated to an improvement of ST resolution and a reduced distal embolization [41][42][43][44]. As consequence of this large randomized trial, ACC/AHA/SCAI guidelines reported that the 'usefulness of selective and bailout aspiration thrombectomy in patients undergoing primary PCI is not well established (Class II; level of evidence B)' and the routine use of manual aspiration during primary PCI is not useful (Class III; level of evidence A) [2].…”

Section: Manual Thrombectomymentioning

confidence: 99%

Current and novel approaches to treat patients presenting with ST elevation myocardial infarction

Mancone

Mieghem

Zijlstra

et al. 2016

Expert Review of Cardiovascular Therapy

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Introduction: Primary percutaneous coronary intervention (PCI) represents the gold-standard treatment for patients presenting with an ST-elevation myocardial infarction (STEMI). Acute myocardial infarction is a complex clinical scenario, and an appropriate therapeutic approach could be represented by a balanced integration between healthcare system and medical competence. Areas covered: In this review we discuss how a primary PCI network, and the new therapeutic options could be coupled in order to obtain improved clinical outcomes. The present report will focus on three main issues related to STEMI patients, namely, out of hospital management, primary PCI and pharmacological treatment. Expert commentary: A possible correct approach to a patient presenting a STEMI could be considered as a stepwise process, given by 5 steps: reducing the time to reperfusion; dual antiplatelet administration; radial access; new generation drug eluting stent implantation; long term management. ARTICLE HISTORY

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“…Accordingly, careful thromboaspiration was advocated to optimize acute procedural results and to prevent the occurrence of late acquired malapposition resulting from the disappearance of the residual thrombus entrapped behind the stent (1,2). However, the widespread systematic utilization of manual thrombus aspiration during routine primary angioplasty procedures has been recently halted in the light of the negative results of 2 large controlled trials of routine thromboaspiration in STEMI powered for major clinical events (1,3). Moreover, the delayed healing and the potential toxic effects on the vessel wall leading to positive remodeling and late acquired malapposition occasionally Perspective Bioresorbable vascular scaffolds in patients with acute myocardial infarction: a new step forward to optimized reperfusion?…”

Section: Introductionmentioning

confidence: 99%

Bioresorbable vascular scaffolds in patients with acute myocardial infarction: a new step forward to optimized reperfusion?

Alfonso¹,

Cuesta²,

Bastante³

et al. 2016

J. Thorac. Dis.

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Bioresorbable vascular scaffolds (BVS) represent a disruptive technology that has caused a new revolution in interventional cardiology. BVS appear to be particularly appealing in patients presenting with an acute myocardial infarction (MI). The available evidence on the value of BVS implantation in this challenging scenario is very promising but still limited. Results come from preliminary small observational studies, prospective registries that include a control group, and from scarce randomized clinical trials with surrogate mechanistic or angiographic primary end-points. Further studies, powered for clinical endpoints, are required to establish the relative safety and efficacy of BVS vs. new-generation metallic drug-eluting stents (DES) in patients with ST-segment elevation acute MI.

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Outcomes after thrombus aspiration for ST elevation myocardial infarction: 1-year follow-up of the prospective randomised TOTAL trial

Cited by 186 publications

References 28 publications

Management of Intracoronary Thrombus

Management of Intracoronary Thrombus

Current and novel approaches to treat patients presenting with ST elevation myocardial infarction

Bioresorbable vascular scaffolds in patients with acute myocardial infarction: a new step forward to optimized reperfusion?

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