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Comparison of manual with mechanical aspiration thrombectomy in patients presenting with acute coronary syndrome
Matthew Nardi1, Mohamed Rezk2, Jorge Escobar1
1Department of Cardiology, The Texas Heart Institute, Houston, TX, USA; Baylor St. Luke's Medical Center, Houston, TX, USA.
Insights
Manual and mechanical thrombectomy are equally safe and effective for reducing thrombus burden in acute coronary syndrome (ACS) patients. Both methods significantly improve coronary flow and myocardial perfusion, offering similar outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Routine manual aspiration thrombectomy shows limited benefit in acute coronary syndrome (ACS).
- Selective mechanical thrombectomy may improve outcomes in ACS patients with high thrombus burden.
- This study compares manual (MaT) vs. mechanical thrombectomy (MeT) in ACS.
Purpose of the Study:
- To compare the safety and efficacy of MaT and MeT.
- To evaluate the impact on coronary flow and myocardial perfusion.
- To assess outcomes in ACS patients with high thrombus burden.
Main Methods:
- Retrospective review of 70 ACS patients (May 2019-Feb 2024).
- 27 patients received MaT, 43 received MeT.
- Analysis included thrombus grade, coronary flow, myocardial blush, survival, and stroke.
Main Results:
- No significant difference in baseline thrombus burden between MaT and MeT groups.
- Both methods significantly reduced thrombus burden and improved coronary flow and blush.
- Similar post-procedure rates for TIMI thrombus grade 0, TIMI flow grade 3, and Myocardial Blush grade 3.
- Survival to discharge was comparable (88% MaT vs. 84% MeT).
Conclusions:
- Selective thrombectomy is safe and effective for ACS patients with high thrombus burden.
- Both manual and mechanical thrombectomy demonstrate similar efficacy and safety profiles.
- Improved coronary flow and myocardial perfusion are achieved with both techniques.
Background:
Routine manual aspiration thrombectomy has shown limited benefit in patients with acute coronary syndrome (ACS). Selective application of mechanical thrombectomy in patients with ACS and high thrombus burden may improve coronary flow and myocardial perfusion. We aimed to compare safety and efficacy between manual (MaT) and mechanical aspiration thrombectomy (MeT) in this population.
Methods:
Retrospective review of 70 patients presenting with ACS between May 2019 and February 2024, with 27 receiving MaT and 43 MeT. Our comparative analysis included Thrombolysis in Myocardial Infarction (TIMI) thrombus grade, TIMI flow grade, Myocardial Blush grade, survival to discharge and stroke.
Results:
There was no difference in the clinical characteristics of the two groups except higher prevalence of hypertension in the MaT group (93 % vs 70 % in MeT, p = 0.02). Baseline thrombus burden did not differ between groups. Both MaT and MeT resulted in a significant reduction in thrombus burden and improvement in coronary flow and myocardial blush. MaT and MeT had similar post-thrombectomy rates of TIMI thrombus grade 0 (63 % vs 77 %, p = 0.3), TIMI flow grade 3 (70 % vs 67 %, p = 1) and Myocardial Blush grade 3 (44 % vs 51 %, p = 0.6). One stroke was reported in the MeT group. Finally, Survival to discharge was similar (MaT 88 % vs MeT 84 %, p = 0.7).
Conclusions:
Selective thrombectomy in ACS patients with high thrombus burden is safe and effectively reduces thrombus burden while improving coronary flow and myocardial perfusion. Manual and mechanical thrombectomy show similar efficacy and safety profiles.
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