Does thrombo-aspiration still have a place in the treatment of myocardial infarction?

Thrombectomy for the treatment of ST elevation myocardial infarction (STEMI) is a simple and intuitive idea. In the 2000s, several studies evaluated the efficacy of thrombus aspiration and showed that thrombus aspiration led to improved myocardial perfusion, as assessed by a range of surrogate endpoints. These findings were confirmed by meta-analyses. However, the favorable results with thrombo-aspiration in STEMI were subsequently called into question by data indicating not only a lack of efficacy, but a risk of potentially deleterious complications.

We review here the scientific evidence in favor of, then subsequently against the utility of thrombo-aspiration in the setting of STEMI, and examine how such discordant findings come to be observed, e.g. technical problems, faulty study design, weak statistical power, or a true lack of efficacy of thrombus aspiration. We also consider what these conflicting results may mean for the future of this technique in the treatment of ST elevation myocardial infarction. Over the course of its development, significant evidence has cumulated both in favour of, and against thrombectomy for the treatment of ST elevation myocardial infarction. Overall, although its place among the therapeutic armamentarium for ST elevation myocardial infarction is now limited, it is likely that it will continue to be used to treat specific cases, after careful consideration of the limited success of our catheters at retrieving effective thrombus, the risk of stroke linked to the procedure, and the special attention that needs to be paid to avoid a risk of embolization during removal of thrombotic material.