Randomized evaluation of intralesion versus intracoronary abciximab and aspiration thrombectomy in patients with ST-elevation myocardial infarction: The COCTAIL II trial

Prati, Francesco; Romagnoli, Enrico; Limbruno, Ugo; Pawłowski, Tomasz; Fedele, Silvio; Gatto, Laura; Vito, Luca Di; Pappalardo, Alessandro; Ramazzotti, Vito; Picchi, Andrea; Trivisonno, Antonio; Materia, Laura; Pfiatkosky, Piotre; Paoletti, Giulia; Marco, Valeria; Tavazzi, Luigi; Versaci, Francesco; Stone, Gregg W.

doi:10.1016/j.ahj.2015.08.020

Cited by 27 publications

(35 citation statements)

References 30 publications

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“…[8][9][10] In intravascular ultrasound studies, the intrastent tissue prolapse has been associated with a worse prognosis in the setting of PCI for acute MI. [38][39][40] These findings were partially corroborated by preliminary OCT data that were able to relate residual intrastent plaque/thrombus prolapse to surrogate clinical end points such as coronary flow, myocardial reperfusion, 37 and neointimal volume. 41 The Massachusetts General Hospital OCT Registry demonstrated a correlation between intrastent plaque protrusion (>100 µm in 53% of lesions) and the following risk or target lesion revascularization in the first year of follow-up; thrombus prolapse (defined as a mass with diameter >250 μm attached to the luminal surface, stent strut, or floating within the lumen) was observed in 39% of lesions but was not predictive of worse outcome.…”

Section: The Role Of Residual Intrastent Plaque/thrombus Protrusionsupporting

confidence: 64%

“…Recent data from the COCTAIL II 37 and TROFI 42 trials showed no difference in terms of residual intrastent atherothrombotic area regardless of the prestent thrombotic load and the different strategies adopted in primary PCI, including thrombus aspiration or local drug delivery of abciximab. Thus, these data seem to suggest that also in acute patients, a more aggressive protocol should be applied by interventional cardiologists to reduce intrastent tissue prolapse or its distal embolization, potentially including prolonged higher pressure balloon inflations, 42 distal protection, or even mesh stents together with pharmaceutical solutions such as more potent antiplatelet agents.…”

Section: Interplay Among Oct Features Of Stent Positioning In Patientmentioning

confidence: 99%

“…11,37 Previous angiographic studies related intrastent residual thrombus to an increased risk of periprocedural MI (ie, distal embolization) and stent thrombosis (eg, inadequate vessel healing). [8][9][10] In intravascular ultrasound studies, the intrastent tissue prolapse has been associated with a worse prognosis in the setting of PCI for acute MI.…”

Section: The Role Of Residual Intrastent Plaque/thrombus Protrusionmentioning

confidence: 99%

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Clinical Impact of Suboptimal Stenting and Residual Intrastent Plaque/Thrombus Protrusion in Patients With Acute Coronary Syndrome

Prati

Romagnoli

Gatto

et al. 2016

Circ: Cardiovascular Interventions

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P laque rupture and thrombus formation play a key role in the pathogenesis of acute coronary syndrome (ACS). 1 Moreover, in this clinical setting, percutaneous coronary intervention (PCI) can be hampered by distal embolization of plaque debris and thrombus components, the main determinants of the no-reflow phenomenon.2 The introduction ofBackground-Clinical consequences of optical coherence tomographic (OCT) high-definition visualization of plaque/ stent structures in acute patients remain undefined. In this retrospective substudy, we assessed the prognostic impact of postprocedural culprit lesion OCT findings in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Methods and Results-In the CLI-OPCI (Centro per la Lotta Contro L'Infarto-Optimization of Percutaneous CoronaryIntervention) database collecting cases from 5 independent OCT-experienced centers, we retrospectively analyzed postprocedural OCT findings in acute coronary syndrome patients and explored its possible impact (specifically that of residual intrastent plaque/thrombus protrusion) on outcome. (HR, 8.50; P<0.001) stent edges. Postprocedural OCT assessment of treated culprit lesion revealed at least one of these parameters in 55.2% of cases, with an associated increased risk of device-oriented cardiovascular events during follow-up (17.9% versus 4.8%; P<0.001). Both the presence of at least one of these parameters (HR, 3.69; P=0.002) and the residual intrastent plaque/thrombus protrusion (HR, 2.83; P=0.008) were confirmed as independent predictors of device-oriented cardiovascular events. Conclusions-In this retrospective study of acute coronary syndrome patients undergoing percutaneous coronary intervention, a composite of OCT-defined suboptimal stent implantation characteristics at the culprit lesion and residual intrastent plaque/thrombus protrusion was associated with adverse outcome. (Circ Cardiovasc Interv. 2016;9:e003726.

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Section: The Role Of Residual Intrastent Plaque/thrombus Protrusionsupporting

confidence: 64%

Section: Interplay Among Oct Features Of Stent Positioning In Patientmentioning

confidence: 99%

Section: The Role Of Residual Intrastent Plaque/thrombus Protrusionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Impact of Suboptimal Stenting and Residual Intrastent Plaque/Thrombus Protrusion in Patients With Acute Coronary Syndrome

Prati

Romagnoli

Gatto

et al. 2016

Circ: Cardiovascular Interventions

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“…Eighteen trials were retrieved, encompassing 20 641 patients: 10 331 patients underwent routine aspiration thrombectomy prior to primary PCI and 10 310 patients were in the conventional primary PCI arm. 8,11,[14][15][16][17][18][24][25][26][27][28][29][30][31][32][33][34] (For a summary of the Cochrane risk-of-bias assessment tool and the quality measures for the individual trials, see Supporting Information, Tables 1 and 2, in the online version of this article.) All trials were retrieved from Medline, and the other sources did not identify any further trials.…”

Section: Resultsmentioning

confidence: 99%

“…2 A meta-analysis of randomized trials had previously suggested that aspiration thrombectomy might impact intermediate-term outcomes (ie, 6-12 months). 13 Given that additional trials evaluating the long-term outcomes of aspiration thrombectomy have become available, [11][12][13][14][15][16][17][18] we sought to conduct an updated comprehensive meta-analysis of randomized trials to evaluate the impact of aspiration thrombectomy on long-term clinical outcomes (ie, beyond 6 months).…”

Section: Introductionmentioning

confidence: 99%

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

Elgendy

Mahmoud

Bavry

2017

Clinical Cardiology

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Randomized clinical trials that examined long-term clinical outcomes of routine aspiration thrombectomy prior to primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction have yielded different results. We hypothesized that the routine use of manual thrombus aspiration prior to primary PCI lacks long-term clinical benefits. Electronic databases were searched for randomized trials comparing routine aspiration thrombectomy and conventional PCI. We included only trials that reported clinical outcomes beyond 6 months. The primary outcome was all-cause mortality, and the secondary outcomes

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Intralesional delivery of glycoprotein IIb/IIIa inhibitors in acute myocardial infarction: Review and recommendations

Kirresh

Stone

2021

Cathet Cardio Intervent

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Plaque rupture leads to a cascade of events culminating in collagen disruption, tissue factor release, platelet activation and thrombus formation. Pro-inflammatory conditions, hyperglycemia and smoking predispose to high thrombus burden (HTB) which is an independent predictor of slow or no-reflow. In patients with acute myocardial infarction (AMI), glycoprotein IIb/IIIa inhibitors (GPI) reduce thrombus burden and improve myocardial perfusion. These agents are typically administered systemically via the intravenous route or locally via an intracoronary (IC) route. However, as higher local concentrations of GPI are associated with enhanced platelet inhibition, intralesional (IL) GPI administration may be particularly effective in cases of HTB.Modest-sized randomized trials comparing IL and IC GPI delivery have reported conflicting outcomes. Some trials have demonstrated improved coronary flow and myocardial perfusion with reduced major adverse cardiac events with IL compared with IC GPI administration, whereas others have shown no significant benefits. Furthermore, although no direct comparison has been made between IL delivery using an aspiration catheter, microcatheter or a dedicated balloon-based "weeping" infusioncatheter, improved outcomes have been most consistent following GPI administration at the site of the lesion and thrombus with the dedicated infusion catheter. This review provides an update on the role and outcomes of IL GPI administration in patients with AMI and HTB. Based on the evidence we offer an algorithm demonstrating when to consider IL administration in patients with AMI undergoing intervention. We conclude with a perspective on the management of patients with STEMI and COVID-19 in whom a prothrombotic state often results in HTB.

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Randomized evaluation of intralesion versus intracoronary abciximab and aspiration thrombectomy in patients with ST-elevation myocardial infarction: The COCTAIL II trial

Cited by 27 publications

References 30 publications

Clinical Impact of Suboptimal Stenting and Residual Intrastent Plaque/Thrombus Protrusion in Patients With Acute Coronary Syndrome

Clinical Impact of Suboptimal Stenting and Residual Intrastent Plaque/Thrombus Protrusion in Patients With Acute Coronary Syndrome

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

Intralesional delivery of glycoprotein IIb/IIIa inhibitors in acute myocardial infarction: Review and recommendations

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