Manual thrombus aspiration has been shown to reduce thrombus burden and improve markers of reperfusion. 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. Catheter thrombus aspiration in primary pci was beneficial in randomized clinical trials. 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. 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. The ultimate goal of primary pci is successful myocardial reperfusion. There is no welldesigned, korean data about the clinical impact of intracoronary ta during primary pci in patients with stsegment elevation myocardial infarction stemi. Abrams is professor of medicine, division of cardiology, university of new mexico, albuquerque, and dr. 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. Clinical impact of thrombus aspiration during primary. Although primary pci is the most effective reperfusion strategy for stemi, it fails to.
Is to evaluate the value of thrombus aspiration devices in primary pci compared to conventional primary pci on intermediate and short term follow up. Background primary percutaneous coronary intervention pci is. The removal of the thrombus before stent deployment has shown to im. Procedural and clinical benefits of selective thrombus. The role of manual thrombus aspiration ta during primary percutaneous coronary intervention ppci for acute stsegmentelevation. Background recent studies failed to show clinical benefit of aspiration thrombectomy in stemi patients. The thrombus aspiration during percutaneous coronary intervention in acute myocardial infarction study tapas was a singlecenter, prospective, randomized, open trial. The aim of this study was to evaluate longterm clinical outcome after ta in adjunct to ppci for acute stsegment myocardial.
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 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. The taper registry efficacy and safety of selective thrombus aspiration in real clinical practice retrospectively. Although current clinical guidelines recommend the use of thrombus aspiration ta during primary percutaneous coronary intervention ppci, previous studies evaluating ta demonstrated contradictory results. Oneyear survival according to use of thrombus aspiration. After the initial enthusiasm derived from the mortality reduction shown in early randomized and observational studies 37, disappointing results have been yielded in. Thrombus aspiration during primary percutaneous coronary. The benefit of manual thrombus aspiration ta during primary percutaneous coronary intervention pci remains uncertain, and the effect of ta in relation to. Primary percutaneous coronary intervention ppci is the preferred treatment. Value of thrombus aspiration devices in primary pci on. Eligible patients were randomly assigned to either primary pci with thrombus aspiration or standard pci. Thrombus aspiration during primary percutaneous coronary intervention improves myocardial reperfusion and reduces infarct size. However, no difference between the ta group and the control group receiving balloon angioplasty first line could be.
It is reasonable to use aspiration thrombectomy in patients with a large thrombus burden. 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. 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 ta using manual ta catheters has been reported to improve coronary and myocardial circulation.
Sardella g, mancone m, bucciarelliducci c, agati l, scardala r, carbone i, et al. Recent studies question the value of manual thrombus aspiration ta before pci in patiens with stsegment elevation infarction stemi. Boyle is assistant professor of medicine, interventional cardiology, university of california, san francisco dr. We assessed oneyear survival in stemi patients participating in the fastmi 2010 registry according to use of. Procedural and clinical benefits of selective thrombus aspiration in. Thrombus aspiration in primary percutaneous coronary intervention. Stsegment elevation myocardial infarction stemi remains an important cause of morbidity and mortality. In the usa, the development of an organized stemi network has allowed stemi patients greater access to primary pci. We need to assess the longterm outcomes in the form of reduction in infarct size using this strategy in large group of patients. 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. Thrombus aspiration in primary percutaneous coronary. This study sought to test the hypothesis that thrombus removal, with a new manual thrombusaspirating device, before primary percutaneous coronary intervention ppci may improve. In this issue of open heart, hoole et al 1 present the impact trial. Thrombus aspiration during primary percutaneous coronary intervention.
Thrombus aspiration in stemi thrombus aspiration in stemi marmagkiolis, konstantinos. 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. The most important goal in the management of stemi is timely reperfusion and establishment of normal coronary flow. 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. Immediate or primary percutaneous coronary intervention pci is a central treatment for stemi. Thus, although the epicardial vessel may appear to be. Manual thrombus aspiration during primary percutaneous intervention pci provides us with aspirated thrombus sample, histopathological analysis of which can yield valuable information.
The two principal strategies to achieve this goal are thrombus aspiration and intracoronary administration of glycoprotein iibiiia inhibitors gpis. Whether the use of thrombus aspiration during primary pci for stemi is associated with decreased mortality remains a matter of debate. Thrombus aspiration in stemi, current treatment options in. Thrombus aspiration in stsegmentelevation myocardial. The clinical effect of routine intracoronary thrombus aspiration before primary percutaneous coronary intervention pci in patients with stsegment elevation myocardial infarction stemi is. We evaluated whether thrombus aspiration ta during primary percutaneous coronary intervention pci reduces adverse clinical outcomes within 30days and 1year periods. Does residual thrombus after aspiration thrombectomy. 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. Pdf thrombus aspiration in primary coronary intervention. Manual thrombus aspiration during primary percutaneous coronary. Background routine thrombus aspiration in patients undergoing primary. Thus, although primary percutaneous coronary intervention is the preferred treatement strategy in. Thrombus aspiration for stsegmentelevation myocardial.
The study included 60 patients with acute myocardial infarction undergoing primary. Impact of thrombus aspiration on clinical outcomes in. A third modality, prevention of distal embolization by proximal or distal occlusion devices, has not been shown to be beneficial 16. We enrolled 3 stemi patients presenting with timi flow grade 0 or 1 in the infarct related artery at baseline angiogram undergoing primary pci. We studied various histopathological and immunohistological features of coronary thrombus aspirated in patients with acute st segment elevation myocardial infarction.
Intracoronary abciximab in stemi using local drug delivery. Thrombus aspiration during stsegment elevation myocardial. Save your blushes and stop routine thrombus aspiration. We aimed to evaluate the impact of thrombus aspiration ta during primary percutaneous coronary intervention ppci in realworld settings. Value of thrombus aspiration in primary pci 20080401. By jonathan abrams, md, and andrew boyle, mbbs, phd dr. Patients are not treated with thrombolytic therapy in the emergency room or ambulance but.
Thrombus aspiration improves clinical outcomes in stemi. Tapas investigated whether thrombus aspiration was better than conventional treatment of angioplasty without thrombus aspiration during primary pci in patients with myocardial infarction. Prognostic value of manual thrombus aspiration in patients. The current study sought to evaluate the clinical and angiographic outcome of thrombus aspiration during primary pci in diabetic patients presented with stemi. 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. Ppt thrombus aspiration during percutaneous coronary. 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. 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. Manual thrombus aspiration is not associated with reduced. Procedural and clinical benefits of selective thrombus aspiration in primary pci. As a routine strategy, thrombus aspiration did not reduce cardiovascular mortality for patients with stsegmentelevation myocardial infarction undergoing primary percutaneous coronary intervention.
Study examines predictors of thrombus aspiration failure. 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 patients with high thrombus. Thrombus aspiration during percutaneous coronary intervention in acute myocardial infarction study t a free powerpoint ppt presentation displayed as a flash slide show on. 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. Adverse outcomes after primary pci erasmus universiteit rotterdam. 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. Primary percutaneous coronary intervention an overview. Predictors of failed thrombus aspiration in patients. Angiographic and clinical impact of successful manual. Mechanical reperfusion by primary percutaneous coronary intervention pci is the most effective method to restore coronary circulation. 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. Thrombus aspiration in acute myocardial infarction open access.
We suggest not routinely performing thrombus aspiration in primary pci. The primary end point was a myocardial blush grade of 0 or 1 defined as absent or minimal myocardial reperfusion, respectively. Patients were divided in two groups based on whether thrombus aspiration was attempted. Manual thrombus aspiration in stemi treatment cardiac. Closure device or manual compression in patients undergoing percutaneous. Primary left main coronary artery thrombus aspiration as a. Pdf coronary thrombus in patients undergoing primary pci for.
Distal embolic protection does not appear to protect against noreflow in the native coronary circulation but is effective in svgs. Lack of longterm clinical benefit of thrombus aspiration. However, no difference between the ta group and the control group receiving balloon angioplasty. The study included 60 patients with acute myocardial infarction undergoing primary pci, all patients submitted to history taking, general. 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. Removing thrombus from hardtoreach vessels requires a highly deliverable, atraumatic catheter. Randomized trial of primary pci with or without routine manual thrombectomy. The trial was a singlecentre, randomised open study with blinded assessment of endpoints.
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