"Lone aspiration thrombectomy" without stenting in young patients with ST elevation myocardial infarction

Plaque rupture with thrombotic occlusion without severe underlying coronary atherosclerosis is frequently observed during primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI). These lesions are stented even if post thrombectomy mild underlying coronary artery disease (CAD) is noted. The value of mechanical thrombus aspiration alone "lone aspiration thrombectomy" (LAT) without stenting is not well studied. We present a retrospective analysis of patients receiving LAT as the only pPCI therapy for STEMI. Between January 2008 and March 2012, 202 young patients underwent pPCI for acute STEMI at our institution. From this group 10 patients had LAT as definitive therapy. LAT was favored if post thrombectomy minimal underlying CAD was noted, and concerns regarding long term treatment cost and compliance with dual antiplatelet therapy (DAPT) was an issue. All patients received ASA, clopidogrel, heparin and eptifibatide. DAPT was maintained for at least 1 month. One patient was lost to follow-up. At one month, all remaining 9 patients were free of MACE. At six weeks one patient had recurrent STEMI after abruptly discontinuing all his medications. Re-occlusion at the site of prior plaque rupture was stented, and treatment compliance was urged. Short term follow up at 2 months available for 5 patients and 2 years for 3 patients revealed no adverse consequences, the remaining patients had returned to their home countries.

In selected young patients presenting with acute STEMI, LAT without balloon angioplasty or stenting is feasible and is associated with favorable short and long-term outcome.