Document Detail

Thrombus Aspiration in Primary Angioplasty for ST-segment Elevation Myocardial Infarction.
MedLine Citation:
PMID:  24939382     Owner:  NLM     Status:  In-Data-Review    
Mechanical reperfusion with primary percutaneous coronary intervention in acute ST-segment-elevation myocardial infarction is superior to fibrinolysis in terms of short-term and long-term outcome, provided that it can be delivered on time and by an experienced team. Balloon angioplasty and stent implantation of an occluded epicardial vessel during ST-segment-elevation myocardial infarction can cause disruption of the frail thrombus containing lesions associated with suboptimal myocardial reperfusion and microcirculatory obstruction. Distal embolization of atherothrombotic material can be prevented by thrombus aspiration during primary angioplasty. Mechanical aspiration via end-hole large-lumen thrombectomy catheters has been shown to improve Thrombolysis in Myocardial Infarction (TIMI) flow and result in a more consistent early resolution of ST-segment elevation in multiple registries. More recently, a more sophisticated quantification of the myocardial damage has been applied using myocardial scintigraphy and magnetic resonance, with no difference between patients treated with thrombectomy and patients treated with conventional therapy. The expectations in terms of lasting mortality benefit raised by the first Dutch single-center randomized trial of thrombectomy versus predilation with plain old balloon angioplasty (Thrombus Aspiration During Percutaneous Coronary Intervention in Acute Myocardial Infarction, TAPAS) were not confirmed by a much larger Swedish trial (Thrombus Aspiration ST-Segment Elevation Myocardial Infarction, TASTE) showing no outcome changes. Although we are waiting for new trials to clarify these controversial results, thrombectomy is still used in selected patients with high thrombus load or with persistent occlusion of the infarct-related artery after wire passage. Here we review the various systems available and discuss their relative merits and the reported results.
Roberta Serdoz; Michele Pighi; Nikolaos V Konstantinidis; Ismail Dogu Kilic; Sara Abou-Sherif; Carlo Di Mario
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Current atherosclerosis reports     Volume:  16     ISSN:  1534-6242     ISO Abbreviation:  Curr Atheroscler Rep     Publication Date:  2014 Aug 
Date Detail:
Created Date:  2014-06-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100897685     Medline TA:  Curr Atheroscler Rep     Country:  United States    
Other Details:
Languages:  eng     Pagination:  431     Citation Subset:  IM    
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