Related Experiment Video
Updated: Jun 26, 2026
The Stroke Preclinical Assessment Network Multi-Laboratory Model of Thromboembolic Stroke with Thrombolysis: TE-MCAo
Published on: December 19, 2025
Efficacy of using 50 mL syringe manual thrombectomy catheter in patients with heavy thrombus burden undergoing
Arafa Gomaa Mohamed1, Hamada Alsheikh2, Mahmoud F Elshahat3
1Cardiology Department, Faculty of Medicine, Helwan University, Cairo, Egypt.
Insights
Increasing syringe volume for manual thrombectomy in ST-segment elevation myocardial infarction (STEMI) patients improved reperfusion and heart recovery. A 50 mL syringe enhanced clot retrieval, offering a cost-effective alternative to mechanical devices.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Patients with ST-segment elevation myocardial infarction (STEMI) and high thrombus burden face risks of distal embolization and poor reperfusion during primary percutaneous coronary intervention (PPCI).
- Conventional 30 mL manual aspiration thrombectomy has shown limited efficacy in large trials.
- Increasing syringe volume may improve suction efficiency and clot retrieval.
Purpose of the Study:
- To evaluate the efficacy of a 50 mL syringe compared to a 30 mL syringe for manual aspiration thrombectomy in STEMI patients with high thrombus burden.
- To assess the impact on reperfusion, myocardial recovery, and procedural outcomes.
Main Methods:
- A prospective cohort study included 88 STEMI patients with thrombus burden grade 4-5 undergoing PPCI.
- Patients were assigned to thrombectomy using either a 30 mL syringe (Group I, n=44) or a 50 mL syringe (Group II, n=44) with an Export Advance catheter.
- Primary endpoints included post-procedural Thrombolysis In Myocardial Infarction (TIMI) 3 flow and Myocardial Blush Grade (MBG).
Main Results:
- The 50 mL syringe group demonstrated significantly higher rates of TIMI 3 flow (77% vs. 59%) and MBG 3 (59% vs. 45%).
- Superior outcomes were observed in the 50 mL group for ST-segment resolution, immediate and one-month wall motion score index (WMSI), and left ventricular ejection fraction (LVEF).
- Cardiovascular events were numerically lower in the 50 mL group at 30 days, with no increase in procedural complications.
Conclusions:
- Manual thrombectomy with a 50 mL syringe significantly improved reperfusion and myocardial recovery in STEMI patients with high thrombus burden compared to a 30 mL syringe.
- This simple, low-cost modification offers a practical alternative to mechanical aspiration systems.
- Further validation in larger randomized trials is warranted.
Background:
Patients with ST-segment elevation myocardial infarction (STEMI) and heavy thrombus burden are at increased risk of distal embolisation and impaired reperfusion during primary percutaneous coronary intervention (PPCI). Conventional manual aspiration thrombectomy with a 30 mL syringe has shown limited benefit in large randomised trials. Increasing syringe volume to 50 mL may enhance suction efficiency and clot retrieval, offering a simple and cost-effective strategy to optimise reperfusion.
Methods:
In this prospective cohort study, 88 consecutive STEMI patients with angiographic thrombus burden grade 4-5 undergoing PPCI were included. Group I (n = 44) underwent thrombectomy with a 30 mL syringe, while Group II (n = 44) underwent thrombectomy with a 50 mL syringe using an Export Advance catheter. Primary endpoints were post-procedural thrombolysis in myocardial infarction (TIMI) 3 flow and myocardial blush grade (MBG). Secondary endpoints included ST-segment resolution, echocardiography recovery (wall motion score index [WMSI] and left ventricular ejection fraction [LVEF]), and 30-day adverse cardiovascular events.
Results:
Baseline clinical and laboratory characteristics were comparable between groups. The 50 mL syringe group achieved higher rates of complete reperfusion (TIMI 3 flow: 77% vs. 59%, p = 0.04; MBG 3: 59% vs. 45%, p = 0.05). The primary composite endpoint of TIMI 3 flow plus MBG 3 was significantly greater in Group II (59% vs. 41%, p = 0.04). ST-segment resolution (68 % 15% vs. 55 ± 12%, p = 0.01), immediate post-PCI WMSI (1.7 ± 0.4 vs. 2.1 ± 0.5, p = 0.002), one-month WMSI (1.5 ± 0.3 vs. 1.8 ± 0.4, p = 0.001), and LVEF (54 ± 5% vs. 49 ± 6%, p = 0.002) were all superior in the 50 mL group. At 30 days, cardiovascular events were numerically lower with the 50 mL syringe (2.3% vs. 4.1%, p = 0.17), with no increase in procedural complications.
Conclusion:
In STEMI patients with high thrombus burden undergoing PPCI, manual thrombectomy with a 50 mL syringe improved reperfusion, myocardial recovery, and procedural outcomes compared with the conventional 30 mL syringe, without added risk. This low-cost, accessible modification may represent a practical alternative to mechanical aspiration systems, warranting validation in larger randomised trials.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care