Background recent studies failed to show clinical benefit of aspiration thrombectomy in stemi patients. The removal of the thrombus before stent deployment has shown to im. However, no difference between the ta group and the control group receiving balloon angioplasty. Recent studies question the value of manual thrombus aspiration ta before pci in patiens with stsegment elevation infarction stemi. Eligible patients were randomly assigned to either primary pci with thrombus aspiration or standard pci. Indigo system with cat rx coronary aspiration catheter the aim of mechanicalpower thrombus aspiration is to deliver consistent suction throughout the aspiration cycle in order to maximize efficiency of thrombus removal figure 1. Procedural and clinical benefits of selective thrombus. Immediate or primary percutaneous coronary intervention pci is a central treatment for stemi. Thrombus aspiration improves clinical outcomes in stemi. This study sought to test the hypothesis that thrombus removal, with a new manual thrombusaspirating device, before primary percutaneous coronary intervention ppci may improve. The clinical effect of routine intracoronary thrombus aspiration before primary percutaneous coronary intervention pci in patients with stsegment elevation myocardial infarction stemi is. The aim of this study was to evaluate longterm clinical outcome after ta in adjunct to ppci for acute stsegment myocardial. Study examines predictors of thrombus aspiration failure.
Thus, although the epicardial vessel may appear to be. The goal here was to assess the impact of selective ta during primary percutaneous coronary intervention ppci, its safety and clinical benefits at 1year followup. Thrombus aspiration during primary percutaneous coronary intervention ppci has been used to improve myocardial perfusion through a reduction of the thrombotic burden eventually resulting into better clinical outcomes 1,2. The aim of this study was to evaluate the impact of ta in a contemporary cohort of patients admitted to our hospital with stemi who were undergoing primary percutaneous coronary intervention ppci. Procedural and clinical benefits of selective thrombus aspiration in primary pci. Thrombus aspiration is applicable in a large majority of patients with myocardial infarction with stsegment elevation, and it results in better reperfusion and clinical outcomes than conventional pci, irrespective of clinical and angiographic characteristics at baseline. Although current clinical guidelines recommend the use of thrombus aspiration ta during primary percutaneous coronary intervention ppci, previous studies evaluating ta demonstrated contradictory results. Mechanical reperfusion by primary percutaneous coronary intervention pci is the most effective method to restore coronary circulation. Stsegment elevation myocardial infarction stemi remains an important cause of morbidity and mortality.
Thrombus aspiration in primary percutaneous coronary intervention. Abrams is professor of medicine, division of cardiology, university of new mexico, albuquerque, and dr. Predictors of failed thrombus aspiration in patients. Read thrombus aspiration during primary percutaneous coronary intervention in acute stelevation myocardial infarction, cardiovascular revascularization medicine on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at. Thrombus aspiration in primary percutaneous coronary. Primary percutaneous coronary intervention an overview. Thrombus aspiration ta using manual ta catheters has been reported to improve coronary and myocardial circulation. As a routine strategy, thrombus aspiration did not reduce cardiovascular mortality for patients with stsegmentelevation myocardial infarction undergoing primary percutaneous coronary intervention. Does residual thrombus after aspiration thrombectomy. Objectives the aim of this study was to evaluate if residual thrombus burden after aspiration thrombectomy affects the outcomes of primary percutaneous coronary intervention in patients with stsegment elevation myocardial infarction stemi. The 3 eligible randomized trials tapas thrombus aspiration during percutaneous coronary intervention in acute myocardial infarction, taste thrombus aspiration in stelevation myocardial infarction in scandinavia, and total trial of routine aspiration thrombectomy with pci versus pci alone in patients with stemi enrolled 19 047 patients. The role of manual thrombus aspiration ta during primary percutaneous coronary intervention ppci for acute stsegmentelevation.
By jonathan abrams, md, and andrew boyle, mbbs, phd dr. Primary percutaneous coronary intervention pci refers to the strategy of taking a patient who presents with stemi directly to the cardiac catheterization laboratory to undergo mechanical revascularization using balloon angioplasty, coronary stents, aspiration thrombectomy, and other measures. Thrombus aspiration in stemi, current treatment options in. Background primary percutaneous coronary intervention pci is. Background routine thrombus aspiration in patients undergoing primary.
The ultimate goal of primary pci is successful myocardial reperfusion. The benefit of manual thrombus aspiration ta during primary percutaneous coronary intervention pci remains uncertain, and the effect of ta in relation to. Manual thrombus aspiration is not associated with reduced. Whether the use of thrombus aspiration during primary pci for stemi is associated with decreased mortality remains a matter of debate. Lack of longterm clinical benefit of thrombus aspiration. In this issue of open heart, hoole et al 1 present the impact trial. We assessed oneyear survival in stemi patients participating in the fastmi 2010 registry according to use of. Sardella g, mancone m, bucciarelliducci c, agati l, scardala r, carbone i, et al. Clinical impact of thrombus aspiration during primary. Thus, although primary percutaneous coronary intervention is the preferred treatement strategy in.
Thrombus aspiration during primary percutaneous coronary intervention. Procedural and clinical benefits of selective thrombus aspiration in. The most important goal in the management of stemi is timely reperfusion and establishment of normal coronary flow. Removing thrombus from hardtoreach vessels requires a highly deliverable, atraumatic catheter. There is no welldesigned, korean data about the clinical impact of intracoronary ta during primary pci in patients with stsegment elevation myocardial infarction stemi. However, no difference between the ta group and the control group receiving balloon angioplasty first line could be. Value of thrombus aspiration in primary pci 20080401. Thrombus aspiration in patients with high thrombus. Intracoronary abciximab in stemi using local drug delivery.
After the initial enthusiasm derived from the mortality reduction shown in early randomized and observational studies 37, disappointing results have been yielded in. Manual thrombus aspiration has been shown to reduce thrombus burden and improve markers of reperfusion. The taper registry efficacy and safety of selective thrombus aspiration in real clinical practice retrospectively. Thrombectomy, thrombus aspiration, mortality, portugal, primary pci, angioplasty background the impact of thrombus aspiration ta during primary percutaneous coronary intervention ppci has been widely discussed in the recent years. Pdf coronary thrombus in patients undergoing primary pci for. The authors investigate the effect of thrombus aspiration ta on changes in microvascular function during primary percutaneous coronary intervention ppci for st elevation myocardial infarction stemi. Thrombus aspiration in stsegmentelevation myocardial. We need to assess the longterm outcomes in the form of reduction in infarct size using this strategy in large group of patients. The study included 60 patients with acute myocardial infarction undergoing primary.
It is reasonable to use aspiration thrombectomy in patients with a large thrombus burden. We enrolled 3 stemi patients presenting with timi flow grade 0 or 1 in the infarct related artery at baseline angiogram undergoing primary pci. Randomized trial of primary pci with or without routine manual thrombectomy. Aspiration thrombectomy was performed at the operators discretion and success was defined as effective thrombus aspiration by a dedicated catheter with the achievement of a final timi flow 0. Patients are not treated with thrombolytic therapy in the emergency room or ambulance but. The trial was a singlecentre, randomised open study with blinded assessment of endpoints. Value of thrombus aspiration devices in primary pci on.
Primary percutaneous coronary intervention ppci is the preferred treatment. We aimed to evaluate the impact of thrombus aspiration ta during primary percutaneous coronary intervention ppci in realworld settings. Pdf thrombus aspiration in primary coronary intervention. Manual thrombus aspiration is not associated with reduced mortality in patients treated with primary percutaneous coronary intervention an observational study of 10,929 patients with stsegment elevation myocardial infarction from the london heart attack group daniel a.
However, in unselected patients with stelevation myocardial infarction stemi, direct stenting has never been shown to improve myocardial perfusion or clinical outcome compared with predilatation. The current study sought to evaluate the clinical and angiographic outcome of thrombus aspiration during primary pci in diabetic patients presented with stemi. We performed a retrospective study, using data from the national registry of interventional cardiology rnci 20062012, portugal with stelevation myocardial infarction stemi patients treated with ppci. We studied various histopathological and immunohistological features of coronary thrombus aspirated in patients with acute st segment elevation myocardial infarction. The 2011 pci and 20 stemi guidelines class iia recommendation for aspiration thrombectomy before primary pci was based on the results of 2 rcts and 1 meta. Thrombus aspiration for stsegmentelevation myocardial. Tapas investigated whether thrombus aspiration was better than conventional treatment of angioplasty without thrombus aspiration during primary pci in patients with myocardial infarction. Save your blushes and stop routine thrombus aspiration. The debate on whether to perform routine thrombus aspiration during primary percutaneous coronary intervention pci seemed to have been settled with the publication of two largescale randomized control trials in taste 1 and total. According to current practice, thrombus aspiration is an adjuvant but not routine therapy during primary pci as it prevents distal thrombus embolization and therefore facilitates epicardial and myocardial reperfusion class iib level of evidence a. Thrombus aspiration in acute myocardial infarction open access. Impact of thrombus aspiration on clinical outcomes in.
Thrombus aspiration in stemi thrombus aspiration in stemi marmagkiolis, konstantinos. Thrombus aspiration during percutaneous coronary intervention in acute myocardial infarction study t a free powerpoint ppt presentation displayed as a flash slide show on. A third modality, prevention of distal embolization by proximal or distal occlusion devices, has not been shown to be beneficial 16. Although primary pci is the most effective reperfusion strategy for stemi, it fails to. We evaluated whether thrombus aspiration ta during primary percutaneous coronary intervention pci reduces adverse clinical outcomes within 30days and 1year periods. Boyle is assistant professor of medicine, interventional cardiology, university of california, san francisco dr. We suggest not routinely performing thrombus aspiration in primary pci. However, there is remaining uncertainty about the potential benefit in those patients with high thrombus burden, where there is a biological rationale for greater benefit. Manual thrombus aspiration during primary percutaneous coronary. Thrombus aspiration during stsegment elevation myocardial. Catheter thrombus aspiration in primary pci was beneficial in randomized clinical trials. Thrombus aspiration during primary percutaneous coronary intervention improves myocardial reperfusion and reduces infarct size.
The two principal strategies to achieve this goal are thrombus aspiration and intracoronary administration of glycoprotein iibiiia inhibitors gpis. Manual thrombus aspiration in stemi treatment cardiac. Patients were divided in two groups based on whether thrombus aspiration was attempted. Distal embolic protection does not appear to protect against noreflow in the native coronary circulation but is effective in svgs. Adverse outcomes after primary pci erasmus universiteit rotterdam. Oneyear survival according to use of thrombus aspiration. Manual thrombus aspiration during primary percutaneous intervention pci provides us with aspirated thrombus sample, histopathological analysis of which can yield valuable information. Closure device or manual compression in patients undergoing percutaneous. The primary end point was a myocardial blush grade of 0 or 1 defined as absent or minimal myocardial reperfusion, respectively. Ppt thrombus aspiration during percutaneous coronary. In the usa, the development of an organized stemi network has allowed stemi patients greater access to primary pci. Primary left main coronary artery thrombus aspiration as a. Thrombus aspiration during primary percutaneous coronary. The taste and total trials did not show a statistically significant benefit of thrombus aspiration over pci alone regarding hard clinical endpoints such as recurrent myocardial infarction, cardiogenic shock and mortality.
170 1303 371 895 70 1361 1025 336 137 1544 1028 703 476 562 1010 749 1520 1160 756 984 556 58 243 934 1504 984 1395 33 1529 1090 1346 1198 110 439 1336 869 1397 659 184 831 996