Should Aspiration Thrombectomy Be Performed in All, Most, or Few Primary PCI Procedures?

December 02, 2009

In This Article

Coronary Thrombus

The presence of coronary thrombus creates special challenges in the performance of primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). Large thrombus burden is associated with an increased incidence of distal embolization and no-reflow, and may limit reperfusion at the microvascular level. In addition, large thrombus burden is associated with higher major adverse cardiac event rates and is a strong independent predictor of 2-year mortality (Slide 1).[1] There have been a number of adjunctive strategies to deal with coronary thrombus at the time of primary PCI, and these have included pharmacologic therapies (primarily glycoprotein IIb/IIIa platelet inhibitors), mechanical thrombectomy, embolic protection devices, and manual aspiration.

Slide 1.

Importance of Thrombus Burden - MACE After DES for STEMI