Background: Intracoronary thrombus in acute Myocardial Infarction (MI) confers higher
rates of no-reflow with attendant adverse consequences. Earlier Randomized-Controlled-Trials (RCTs)
of routine thromboaspiration during Percutaneous Coronary Intervention (PCI) indicated a clinical benefit,
but more recent RCTs were negative. However, data of selective use of this adjunctive approach
remain scarce.
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Objective: The aim of this single-centre prospective study was to report the results of selective thromboaspiration
during PCI in patients with intracoronary thrombi, and also to provide an extensive literature
review on current status of thromboaspiration.
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Methods: The study included 90 patients (77 men; aged 59.3±12.7 years) presenting with acute MI (STElevation
MI (STEMI) in 74, non-STEMI in 16) who had intracoronary thrombi and were submitted to
thromboaspiration.
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Results: Total (n=67) or subtotal (n=18) vessel occlusions were present in 85 (94%) patients. Thromboaspiration
and subsequent PCI were successful in 89/90 (98.9%) patients, with coronary stenting in 86
(96.6%). In 4 patients with residual thrombus, a mesh-covered stent was implanted. IIb/IIIa-inhibitors
were administered in 57 (63.3%) patients. No-reflow occurred in only 1 (1.1%) patient. The postprocedural
course was uneventful. Review of the literature revealed several early observational and
RCTs and meta-analyses favouring manual, not mechanical, thrombectomy. However, newer RCTs and
meta-analyses significantly curtailed the initial enthusiasm for the clinical benefits of routine use of
thromboaspiration.
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Conclusion: Selective thromboaspiration for angiographically visible thrombi in MI patients undergoing
PCI, as an adjunct to mechanical reperfusion and to IIb/IIIa-inhibitors, may be an option since this
manoeuvre may improve procedural and clinical outcome.