Optimization in Stent Implantation by Manual Thrombus Aspiration in ST-Segment–Elevation Myocardial Infarction

Abstract

Background-Manual thrombus aspiration (TA) is effective to reduce the thrombus burden during primary percutaneous coronary intervention for ST-elevation myocardial infarction. The objective of this study is to assess the impact of manual TA on stent implantation during primary percutaneous coronary intervention. Methods and Results-Population of the EXAMINATION trial (n=1498) was divided into 2 groups according to the use of TA. Immediate angiographic results, primary patient-oriented end point (combination of all-cause death, myocardial infarction, and any revascularization) and secondary device-oriented end point (combination of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization), definite/probable stent thrombosis, and major/minor bleeding were evaluated at 2 years. .009) was also present in the TA group compared with the nonthrombus aspiration group. At 2-year follow-up, no differences in clinical end point were observed between groups. Conclusions-Manual TA during primary percutaneous coronary intervention is associated with a higher rate of direct stenting, a lower rate of postdilatation, and larger and less stents in comparison with conventional primary percutaneous coronary intervention. Conversely, manual TA had no apparent impact on clinical outcomes at long-term follow-up. Clinical Trial Registration-http://www.clinicaltrials.gov. Unique identifier: NCT00828087.(Circ Cardiovasc Interv. 2014;7:294-300.)

Reduction of atherothrombotic burden before stent deployment in non‐ST elevation acute coronary syndromes: Reduction of myocardial necrosis achieved with nose‐dive manual thrombus aspiration (REMNANT) trial. A volumetric intravascular ultrasound study

“…Erlinge et al recently documented with near‐infrared spectroscopy (NIRS) that TA—beyond thrombus—reduces culprit lesion lipid content by 28% in patients with ACS, thereby removing material that may embolize during stenting, and seems particularly useful if a large lipid core is present at the culprit site . Our results confirm and extend such knowledge, showing that TA adequately prepares culprit lesion before S‐PCI, as in the Everolimus‐eluting stent versus bare‐metal stent in ST‐segment elevation myocardial infarction (EXAMINATION) trial, where TA was associated with a higher rate of direct stenting and with the use of larger and fewer stents in comparison with conventional primary PCI. Here again, in the TOTAL trial an OCT substudy will be conducted to investigate the impact of thrombus removal and optical coherence tomography (OCT)‐guided PCI optimization on stent deployment .…”

Outcomes 1 Year after Thrombus Aspiration for Myocardial Infarction

“…Recently, observational data from 1498 patients with STEMI that was identified in a randomized trial of treatment with drug-eluting stents showed that clinical outcomes with thrombus aspiration were similar to those with stenting alone. 19 Several meta-analyses of randomized trials of thrombus aspiration have had inconsistent results with respect to mortality and other clinical outcomes. 5,12,14 The findings of these meta-analyses are dominated by the results of TAPAS and the TASTE trial.…”

A mechanism for stroke complicating thrombus aspiration

“…Initially it was associated with decreased mortality in randomized trials and meta‐analyses . More recently, larger trials , meta‐analyses , and large registries with over 27,000 patients have found no improvement in clinical endpoints with CTA. As a consequence, updated STEMI guidelines downgraded routine CTA in STEMI from a Class IIa recommendation to a Class III recommendation .…”