Thrombus Aspiration During Primary Percutaneous Coronary Intervention Improves Myocardial Reperfusion and Reduces Infarct Size

Sardella, Gennaro; Mancone, Massimo; Bucciarelli-Ducci, Chiara; Agati, Luciano; Scardala, Raffaele; Carbone, Iacopo; Francone, Marco; Roma, Angelo Di; Benedetti, Giulia; Conti, Giulia; Fedele, Francesco

doi:10.1016/j.jacc.2008.10.017

Cited by 329 publications

(70 citation statements)

References 17 publications

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“…The randomized clinical trial (RCT) TAPAS, in particular, showed that manual thrombus aspiration (TA) improved myocardial reperfusion and reduced mortality in STEMI patients at 1-year follow-up [5,6] . These results, confirmed by other studies [7][8][9][10] , including a meta-analysis [11] of 11321 patients from 20 RCT showing lower rates of late mortality, reinfarction and stent thrombosis in patients underwent manual TA compared with conventional primary PCI, led to a recommendation class Ⅱa for manual TA in patients undergoing primary PCI for STEMI [12] . Nevertheless, the use of the thrombectomy devices is still controversial and not routine in STEMI patients, especially because some studies have shown no impact on clinical outcome [13][14][15][16][17][18][19][20] , such as the TASTE trial [21] .…”

Section: Introductionsupporting

confidence: 72%

“…tween patients treated with or without TA [6,7,10,20,28] except for one brief work [29] that demonstrated a higher stent diameter after manual TA, in STEMI patients treated with bare metal stents. Recently, the TASTE trial [21] also showed the need for fewer stents per procedure in manual TA group in comparison with conventional PCI.…”

Section: Fernández-rodríguez D Et Al Thrombus Aspiration Optimizes mentioning

confidence: 99%

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Does manual thrombus aspiration help optimize stent implantation in ST-segment elevation myocardial infarction?

Fernández-Rodríguez¹,

Álvarez-Contreras²,

Martín-Yuste³

et al. 2014

WJC

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AIM:To evaluate the impact of thrombus aspiration (TA) on procedural outcomes in a real-world ST-segment elevation myocardial infarction (STEMI) registry. METHODS:From May 2006 to August 2008, 542 consecutive STEMI patients referred for primary or rescue percutaneous coronary intervention were enrolled and the angiographic results and stent implantation characteristics were compared according to the performance of manual TA. RESULTS:A total of 456 patients were analyzable and categorized in TA group (156 patients; 34.2%) and non-TA (NTA) group (300 patients; 65.8%). Patients treated with TA had less prevalence of multivessel disease (39.7% vs 54.7%, P = 0.003) and higher prevalence of initial thrombolysis in myocardial infarction flow < 3 (P < 0.001) than NTA group. There was a higher rate of direct stenting (58.7% vs 45.5%, P = 0.009), with shorter (24.1 ± 11.8 mm vs 26.9 ± 15.7 mm, P = 0.038) and larger stents (3.17 ± 0.43 mm vs 2.93 ± 0.44 mm, P < 0.001) in the TA group as compared to NTA group. The number of implanted stents (1.3 ± 0.67 vs 1.5 ± 0.84, P = 0.009) was also lower in TA group. CONCLUSION:In an "all-comers" STEMI population, the use of TA resulted in more efficient procedure leading to the implantation of less number of stents per lesion of shorter lengths and larger sizes. Key words: ST-segment elevation myocardial infarction; Primary percutaneous coronary intervention; Manual thrombus aspiration; Stent; Thrombolysis in myocardial infarction flow Core tip: Thrombus embolization is highly detected in ST-segment elevation myocardial infarction (STEMI) leading to unfavorable clinical outcomes. To prevent thrombus embolization, manual thrombus aspiration (TA) receives a high recommendation during primary percutaneous coronary intervention (PCI) by clinical practice guidelines. However, the TASTE trial, recently published, showing no impact of manual TA on shortterm mortality, has reopened the debate about the role of this technique in STEMI. This study is one the first showing that manual TA optimizes stent implantation during primary PCI resulted in more efficient procedures, leading to the implantation of fewer, shorter and larger stents. OBSERVATIONAL STUDYSubmit a

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Section: Introductionsupporting

confidence: 72%

Section: Fernández-rodríguez D Et Al Thrombus Aspiration Optimizes mentioning

confidence: 99%

Does manual thrombus aspiration help optimize stent implantation in ST-segment elevation myocardial infarction?

Fernández-Rodríguez¹,

Álvarez-Contreras²,

Martín-Yuste³

et al. 2014

WJC

View full text Add to dashboard Cite

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“…Various thrombectomy devices have been developed allowing manual or mechanical removal of intracoronary thrombi. All thrombectomy devices have shown benefits compared with conventional PPCI, when surrogate endpoints, such as angiographic flow assessment, LVEF assessment, infarct size reduction by perfusion imaging, enzymatic analysis and ST-segment resolution were used [26,29,[73][74][75][76][77][78][79] . To date evidences about hard endpoints from randomized controlled trials, comparing manual and mechanical thrombectomy, are limited and even conflicting.…”

Section: Thrombectomy Devicesmentioning

confidence: 99%

“…The EXPIRA trial, evaluating the Export catheter (Medtronic, Inc, Minneapolis, MN) in PPCI, demonstrated improvement in surrogate markers, including myocardial blush grade and ST-segment resolution [78] . The TAPAS trial is the largest randomized trial to date evaluating thrombus aspiration in PPCI for STEMI [26] .…”

Section: Thrombectomy Devicesmentioning

confidence: 99%

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

Vecchio¹

2014

WJC

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Acute ST-elevation myocardial infarction (STEMI) usually results from coronary atherosclerotic plaque disruption with superimposed thrombus formation. Detection of coronary thrombi is a poor prognostic indicator, which is mostly proportional to their size and composition. Particularly, intracoronary thrombi impair both epicardial blood flow and myocardial perfusion, by occluding major coronary arteries and causing distal embolization, respectively. Thus, although primary percutaneous coronary intervention is the preferred treatement strategy in STEMI setting, the associated use of adjunctive antithrombotic drugs and/or percutaneous thrombectomy is crucial to optimize therapy of STEMI patients, by improving either angiographical and clinical outcomes. This review article will focus on the prognostic significance of intracoronary thrombi and on current antithrombotic pharmacological and interventional strategies used in the setting of STEMI to manage thrombotic lesions.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: ST-elevation myocardial infarction; Intracoronary thrombosis; Primary percutaneous coronary intervention; Antithrombotic therapies; Coronary thrombectomyCore tip: Intracoronary thrombosis, is the basic pathophysiologic event in acute ST-elevation myocardial infarction (STEMI), and thrombi are very frequently detected in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Thrombus burden and components are important determinants of prognosis in STEMI, being well-known risk factors for longterm adverse cardiovascular events, distal embolization and stent thrombosis. As a result, percutaneous management of lesions with a consistent thrombotic burden is still challenging in the setting of PPCI for STEMI. Therefore, several pharmacological and interventional strategies, such as thrombectomy have been developed in order to improve PPCI's safety and efficacy, by reducing thrombus burden.

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“…EXPIRA trial [11] was done to evaluate the impact on myocardial perfusion and infarct size as assessed by contrastenhanced magnetic resonance imaging of a manual thrombectomy device, Export Medtronic (EM), as adjunctive therapy in primary percutaneous coronary intervention in a subset of patients with anterior ST-segment elevation myocardial infarction. The results showed that; Myocardial blush grade 2 occurred more frequently in the aspiration group (88%) vs. (60%) in the conventional PCI group and the difference was highly statistically significant (p=0.001) [11].…”

Section: Discussionmentioning

confidence: 99%

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Thrombus Aspiration During Primary Percutaneous Coronary Intervention Improves Myocardial Reperfusion and Reduces Infarct Size

Abstract: Thrombectomy prevents thrombus embolization and preserves microvascular integrity reducing infarct size, and it therefore represents an useful adjunctive therapy in PPCI.

Cited by 329 publications

References 17 publications

Does manual thrombus aspiration help optimize stent implantation in ST-segment elevation myocardial infarction?

Does manual thrombus aspiration help optimize stent implantation in ST-segment elevation myocardial infarction?

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

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