Thrombectomy in acute myocardial infarction: Current evidence, challenges, and emerging technologies

Thrombus burden significantly increases risk of no-reflow and microvascular obstruction and subsequently impacts outcomes in acute myocardial infarction (AMI). While initial studies suggested benefits of thrombus aspiration (TA), recent large trials have questioned its routine use. This review examines the role of thrombectomy in the management of AMI, focusing on its potential to improve myocardial perfusion and mitigate no-reflow risk. Attention should be focused on recognising high thrombus burden and its effect on major adverse cardiovascular events and impaired myocardial reperfusion. Similarly, standardising TA techniques and ensuring appropriate patients' selection may also improve enhance our understanding of the role of thrombectomy in AMI. Emerging technologies such as stent retrievals and mechanical thrombectomy may overcome the limitations of manual thrombectomy devices.