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Updated: Jan 7, 2026

Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques

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Published on: June 11, 2019

Selective Use of Thromboaspiration in STEMI: CMR Evidence Against Routine Practice.

Tom Bourcier¹, Jeremie Riou², Wissam Abi Khalil³

¹UMR CNRS 6015-INSERMU1083, University of Angers, Angers, France; Department of Cardiology, University Hospital of Angers, Angers, France.

The American Journal of Cardiology

|January 3, 2026

Summary

This summary is machine-generated.

Thromboaspiration (TA) during primary PCI for ST-elevation myocardial infarction (STEMI) increases microvascular obstruction (MVO). Its routine use is not recommended, especially in patients with delayed treatment or non-obclusive thrombus.

Keywords:

CMR STEMI microvascular obstruction thromboaspiration

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Published on: March 26, 2018

Area of Science:

Cardiology
Interventional Cardiology
Cardiovascular Imaging

Background:

Thromboaspiration (TA) is an adjunct to primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).
Its impact on microvascular perfusion and injury remains unclear.
Concerns exist regarding potential microvascular damage from TA.

Purpose of the Study:

To evaluate the effect of TA on microvascular obstruction (MVO) in STEMI patients.
Utilized cardiac magnetic resonance (CMR) imaging for assessment.
Investigated a large patient cohort to determine TA's impact on MVO.

Main Methods:

Prospective enrollment of 460 STEMI patients undergoing primary PCI.
TA performed in 42% of patients.
Cardiac magnetic resonance (CMR) imaging at 6 days and 3 months post-PCI.
Propensity score-based average treatment effect (ATE) analysis adjusted for baseline differences.
Subgroup analyses based on symptom-to-treatment time, thrombus burden (TIMI thrombus score), and sex.

Main Results:

Thromboaspiration (TA) was associated with higher MVO incidence (OR 1.52) and extent (SMD 0.42).
This association was significant in patients with delayed reperfusion (>6 hours) and non-occlusive thrombus (TIMI thrombus score 1-4).
Increased MVO risk was observed in men but not in women.

Conclusions:

Thromboaspiration (TA) during primary PCI is linked to increased MVO occurrence and extent.
The risk is heightened in patients with delayed reperfusion or non-occlusive thrombus.
Findings support current guidelines against routine TA and advocate for selective use.