Adjunctive coronary thrombectomy during PCI: A single-center retrospective real-world experience

The role of coronary thrombectomy during percutaneous coronary intervention (PCI) remains controversial. While early studies showed potential benefits, subsequent larger trials failed to confirm and raised concerns about increased stroke risk. Yet, thrombectomy remains a straightforward and widely available technique that may have value in selected high-thrombotic scenarios. This study aimed to assess the safety and efficacy of selective coronary thrombectomy during PCI in a real-world, single-center setting.

We conducted a retrospective cohort study including 2658 consecutive patients with ACS undergoing PCI at our center from 2016 to 2024. The population was divided according to adjunctive coronary thrombectomy during PCI. Baseline clinical, angiographic, and procedural characteristics were assessed. The primary endpoint of cerebrovascular events (stroke and transient ischemic attack [TIA]) and secondary endpoints of stroke, TIA, procedural success, complications, and death were compared between groups.

Patients treated with coronary thrombectomy were significantly younger and more frequently presented with STEMI (93 % vs. 51 %, p < 0.001) and higher Killip class (12 % vs. 8 %, p = 0.001). Coronary thrombectomy was safe as rates of cerebrovascular events were low and comparable between groups (0.6 % vs. 0.4 %, p = 0.2), with no significant differences in stroke or TIA. Procedural mortality was also similar (1 % vs. 0.5 %, p = 0.1). Procedural complications were more frequent in the thrombectomy group (5 % vs. 2 %, p < 0.001), driven by increased no-reflow (1.4 % vs. 0.2 %, p < 0.001). Subgroup analysis in STEMI patients confirmed these findings.

Routine coronary thrombectomy is not recommended; however, our real-world data support the safety of selective coronary thrombectomy in patients with high thrombotic burden, particularly STEMI. When used rationally by experienced operators, thrombectomy was not associated with an increased risk of stroke or procedural mortality. Despite its downgraded status in guidelines, thrombectomy remains a valuable tool when applied with clinical judgment, highlighting the importance of individualized decision-making in contemporary PCI.