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Updated: Apr 29, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Optimization in stent implantation by manual thrombus aspiration in ST-segment-elevation myocardial infarction:
Diego Fernández-Rodríguez1, Ander Regueiro1, Salvatore Brugaletta1
1From the Cardiology Department, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (D.F.-R., A.R., S.B., V.M.-Y., M.M., M.S.); Cardiology Department, University Hospital of Bellvitge, Barcelona, Spain (A.C.); Cardiology Department, Hospital do Meixoeiro, Vigo, Spain (A.I.); Cardiology Department, University Hospital of Sant Pau, Barcelona, Spain (A.S.); Cardiology Department, University Hospital San Carlos, Madrid, Spain (R.H.-A.); Cardiology Department, Hospital General of Alicante, Alicante, Spain (V.M.); Cardiology Department, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands (M.V., P.W.S.); Cardiology Department, University Hospital Bolognini Seriate, Bergamo, Italy (M.T.); Cardiology Department, Amphia Ziekenhuis, Breda, The Netherlands (P.d.H.); Cardiology Department, Hospital Son Dureta, Palma de Mallorca, Spain (A.B.); and Cardiology Department, Hospital Juan Canalejo, A Coruña, Spain (N.V.).
Insights
Manual thrombus aspiration (TA) during primary percutaneous coronary intervention for ST-elevation myocardial infarction did not impact long-term clinical outcomes. However, TA was associated with fewer, larger stents and more direct stenting.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Biomedical Engineering
Background:
- Manual thrombus aspiration (TA) effectively reduces thrombus burden in primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).
- The EXAMINATION trial (NCT00828087) investigated the impact of manual TA on stent implantation during primary PCI.
- Understanding TA's effect on procedural and long-term outcomes is crucial for optimizing STEMI treatment.
Purpose of the Study:
- To assess the impact of manual TA on stent implantation during primary PCI for STEMI.
- To evaluate the effect of TA on immediate angiographic results and long-term clinical endpoints.
- To compare stent number, size, and implantation techniques between TA and non-TA groups.
Main Methods:
- The EXAMINATION trial randomized 1498 patients undergoing primary PCI for STEMI into TA and non-TA groups.
- Immediate angiographic results, stent characteristics, and clinical outcomes (patient- and device-oriented endpoints) were assessed at 2-year follow-up.
- Manual TA was utilized in 65.2% of patients, often in those with poorer initial coronary flow.
Main Results:
- The TA group received fewer (1.35 vs. 1.45) and larger (3.25 vs. 3.11 mm) stents compared to the non-TA group.
- Direct stenting was more frequent (69.2% vs. 43.3%) and post-dilatation less frequent (13.0% vs. 18.0%) in the TA group.
- No significant differences in 2-year patient-oriented or device-oriented composite endpoints were observed between the groups.
Conclusions:
- Manual TA during primary PCI is associated with altered stent implantation strategies, including fewer, larger stents and increased direct stenting.
- Despite procedural differences, manual TA demonstrated no significant impact on long-term clinical outcomes at 2-year follow-up.
- The findings suggest that while TA modifies stent deployment, it does not alter the long-term prognosis for STEMI patients.
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. A total of 976 (65.2%) patients were classified into TA group and 522 (34.8%) patients into nonthrombus aspiration group. Manual TA was most frequently used in patients with worse initial thrombolysis in myocardial infarction flow. The TA group received less number of stents implanted (1.35 ± 0.62 versus 1.45 ± 0.71, P = 0.005) with bigger size (3.25 ± 0.44 versus 3.11 ± 0.46 mm, P < 0.001) compared with the nonthrombus aspiration group. A higher rate of direct stenting (69.2% versus 43.3%, P < 0.001) with lower rate of postdilatation (13.0% versus 18.0%, P < 0.009) 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.
