Related Experiment Video
Updated: Apr 23, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Aspiration thrombectomy in ST-elevation myocardial infarction
1Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Insights
Manual thrombectomy in ST-elevation myocardial infarction (STEMI) shows mixed results. While improving perfusion, large trials like TASTE question its survival benefit, with TOTAL trial pending further data.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Restoring coronary blood flow and microvascular perfusion are critical in ST-elevation myocardial infarction (STEMI) treatment.
- Myocardial perfusion measures like ST segment resolution and myocardial blush grade predict mortality after primary percutaneous coronary intervention (PPCI).
Purpose of the Study:
- To evaluate the effectiveness of manual thrombectomy in improving outcomes for patients with STEMI.
- To analyze existing trial data and ongoing studies regarding thrombectomy's impact on mortality and other clinical endpoints.
Main Methods:
- Review of meta-analyses from small trials on manual and mechanical thrombectomy.
- Analysis of results from large randomized controlled trials including TAPAS, TASTE, and the ongoing TOTAL trial.
- Planned individual patient meta-analysis of TOTAL and TASTE trials.
Main Results:
- Small trials suggest manual thrombectomy improves epicardial and microvascular perfusion with potential survival benefits.
- Mechanical thrombectomy trials show improved ST resolution but no survival effect.
- The TASTE trial found no mortality reduction with manual thrombectomy but suggested fewer rehospitalizations for recurrent MI and stent thrombosis.
- Interpretation of TASTE is cautious due to lower-than-expected mortality.
Conclusions:
- Evidence on manual thrombectomy for STEMI is evolving, with conflicting results from different trials.
- Larger trials like TOTAL and planned meta-analyses are crucial for definitive conclusions on clinical outcomes.
- Further research is needed to clarify the role and optimal use of thrombectomy in STEMI management.
Abstract:
The major challenge in the treatment of ST-elevation myocardial infarction (STEMI) is not only restoration of normal coronary blood flow but also microvascular perfusion. In fact, both electrocardiographic (ST segment resolution) and angiographic measures of myocardial perfusion (myocardial blush grade) have been shown to predict mortality after primary percutaneous coronary intervention (PPCI). Initial enthusiasm for manual thrombectomy arose after the apparent mortality benefit observed in the TAPAS trial (N=1,071). Meta-analyses of small trials suggest that manual thrombectomy improves epicardial and microvascular perfusion with trends towards benefit for survival. On the other hand, meta-analyses of small trials of mechanical thrombectomy show improvement in ST resolution without an effect on survival. Recently, the TASTE trial (N=7,244) showed no reduction in mortality with manual thrombectomy but trends toward reduction in rates of rehospitalisation for recurrent MI and stent thrombosis. The interpretation of TASTE should be cautious given that the trial had a much lower than expected mortality, and modest but important treatment effects cannot be excluded (20-30%). The largest trial, the ongoing TOTAL trial (N=10,700), will help determine the effect of manual thrombectomy for important clinical outcomes. A planned individual patient meta-analysis of the TOTAL and TASTE trials will have approximately 17,000 patients to examine the effect on clinical outcomes.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:29Venous Thrombosis III: Interprofessional Care