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Thrombus Aspiration for ST-Segment-Elevation Myocardial Infarction in Modern Era: Still an Issue of Debate?
Junhua Ge1, Andreas Schäfer1, Georg Ertl1
1From the Department of Cardiology, The Affiliated Hospital of Qingdao University, Shandong Province, China (J.G.); Department of Internal Medicine I (J.G., G.E., P.N.) and Comprehensive Heart Failure Center (J.G., G.E., P.N.), University Hospital Würzburg, Germany; and Department of Cardiology and Angiology, Hannover Medical School, Germany (A.S.).
Insights
Manual thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) for ST-segment-elevation myocardial infarction is debated. This review examines TA
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- The efficacy of manual thrombus aspiration (TA) in primary percutaneous coronary intervention (PPCI) for ST-segment-elevation myocardial infarction (STEMI) remains controversial.
- Recent large randomized trials (TASTE, TOTAL) have not supported routine TA in STEMI patients.
- Despite trial outcomes, TA is still considered by interventional cardiologists for significant thrombus burden during PPCI.
Purpose of the Study:
- To review current knowledge on manual thrombus aspiration (TA) in the context of primary percutaneous coronary intervention (PPCI) for ST-segment-elevation myocardial infarction (STEMI).
- To analyze the instruments, clinical effects (positive and negative), and potential reasons for observed outcomes of TA during PPCI.
- To aid clinical decision-making regarding the selective use of TA in individual STEMI patients undergoing PPCI.
Main Methods:
- Literature review of randomized controlled trials and relevant studies on thrombus aspiration during PPCI.
- Analysis of available data on TA devices and their application.
- Synthesis of clinical outcomes, including benefits and adverse effects, associated with TA in STEMI patients.
Main Results:
- Current evidence from major trials does not support routine thrombus aspiration (TA) in ST-segment-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI).
- Manual TA remains a viable option for interventional cardiologists when faced with a substantial thrombus burden.
- The potential benefit of selective TA based on thrombus burden requires further investigation.
Conclusions:
- The routine use of manual thrombus aspiration (TA) in ST-segment-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) is not supported by current evidence.
- Selective application of TA, guided by thrombus burden, may offer a personalized therapeutic approach.
- Further research is needed to clarify the role and optimal patient selection for TA in PPCI for STEMI.
Abstract:
The role of manual thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) for acute ST-segment-elevation myocardial infarction has been a matter of intense research and debate now. Although recent randomized controlled clinical trials (notably TASTE [Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia] and TOTAL [Trial of Routine Aspiration Thrombectomy With PCI Versus PCI Alone in Patients With STEMI]) do not supply evidence supporting the routine use of TA in patients with ST-segment-elevation myocardial infarction, manual TA remains a therapeutic option for interventional cardiologists when treating patients with substantial thrombus burden during PPCI. It remains unknown whether patients might actually benefit from TA applied in a more selective manner depending on the thrombus burden during PPCI, instead of routine application. In this review, we summarize current knowledge on the instruments used in the TA procedure, positive as well as negative clinical effects of TA during PPCI, and analyze the potential reasons for observed effects, in an effort to help the clinical decision making by physicians for the use of TA in individual ST-segment-elevation myocardial infarction patients during PPCI.