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Adjunctive coronary thrombectomy during PCI: A single-center retrospective real-world experience
António Rocha de Almeida1, Rita Louro1, David Neves1
1Division of Cardiology of Hospital Espírito Santo de Évora, Unidade Local de Saúde Alentejo Central, Évora, Portugal.
Insights
Selective coronary thrombectomy during percutaneous coronary intervention (PCI) is safe for patients with high thrombotic burden, especially STEMI. When used judiciously, it does not increase stroke or mortality risks, supporting individualized decision-making in PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- The role of coronary thrombectomy in percutaneous coronary intervention (PCI) is debated due to conflicting study results and concerns about stroke risk.
- Despite controversy, thrombectomy is a simple technique valuable in specific high-thrombotic scenarios.
- This study evaluates the real-world safety and efficacy of selective coronary thrombectomy during PCI.
Purpose of the Study:
- To assess the safety and efficacy of selective coronary thrombectomy in patients undergoing PCI.
- To compare outcomes, including cerebrovascular events and procedural success, between patients who received thrombectomy and those who did not.
- To evaluate the utility of thrombectomy in a real-world, single-center setting, particularly in patients with acute coronary syndromes (ACS).
Main Methods:
- A retrospective cohort study of 2658 consecutive patients with ACS undergoing PCI from 2016 to 2024.
- Patients were divided into groups based on whether they received adjunctive coronary thrombectomy during PCI.
- Key endpoints included cerebrovascular events (stroke, TIA), procedural success, complications, and mortality, compared between groups.
Main Results:
- Patients receiving thrombectomy were younger and more likely to have STEMI and higher Killip class.
- Coronary thrombectomy was safe, with comparable rates of cerebrovascular events (0.6% vs. 0.4%) and procedural mortality (1% vs. 0.5%) between groups.
- Procedural complications, particularly no-reflow, were more frequent in the thrombectomy group (5% vs. 2%).
Conclusions:
- Routine coronary thrombectomy is not recommended, but selective use in high-thrombotic burden patients (especially STEMI) is supported by real-world data.
- Judicious use by experienced operators was not associated with increased stroke or procedural mortality risks.
- Thrombectomy remains a valuable tool in contemporary PCI when applied with clinical judgment and individualized decision-making.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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