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

December 02, 2009

In This Article

Distal Protection Devices

Outcomes using distal protection devices with primary PCI have also been disappointing. The Enhanced Myocardial Efficacy and Recovery by Aspiration of Liberated Debris (EMERALD) trial randomized STEMI patients to primary PCI with distal protection using balloon occlusion combined with thrombus aspiration (PercuSurge, Medtronic, Inc.) versus primary PCI alone, and found that distal protection provided no improvement in myocardial reperfusion measured by STR and MBG.[4]

Similarly, the Drug Elution and Distal Protection in ST-Elevation Myocardial Infarction (DEDICATION) trial randomized patients undergoing primary PCI to distal protection with a filter (FilterWire-EZ, Boston Scientific) versus primary PCI alone, and found no improvement in myocardial reperfusion with the filter.[5]

Dr. Bavry and Bhatt's meta-analysis evaluated nine randomized trials comparing primary PCI with distal protection using filters or balloon occlusion compared with primary PCI alone and found that distal protection did not improve myocardial reperfusion or clinical outcomes.[3] Based on these data, distal protection is not thought to be beneficial with primary PCI for STEMI except in saphenous vein graft lesions.

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