scholarly journals Thrombus aspiration without stenting in a patient with anterior STEMI: Regression and healing of an unstable plaque assessed by OCT at 24 months of follow‐up

2021 ◽  
Vol 9 (8) ◽  
Author(s):  
Avtandil Babunashvili ◽  
Samir Pancholy ◽  
Tamara Babunashvili ◽  
Alexander Prokhorov
Keyword(s):  
Thrombus Aspiration ◽  
Unstable Plaque

Abstract 12938: Long-Term Mortality Benefit With Intracoronary Thrombus Aspiration Before Primary Percutaneous Coronary Intervention

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Partha Sardar ◽  
Saurav Chatterjee ◽  
Mandeep Singh ◽  
Ramez Nairooz ◽  
Robert Frankel ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Mortality Benefit ◽  
Thrombus Aspiration ◽  
Aspiration Thrombectomy ◽  
Percutaneous Coronary ◽  
Long Term Mortality

Background: Mortality benefit of routine intracoronary thrombus aspiration during primary percutaneous coronary intervention (PCI) has been questioned. The recent TASTE trial did not show a mortality benefit with thrombus aspiration at 1 month, however benefits from accompanying reductions in myocyte injury might accrue over time. A meta-analysis of randomized trials (RCTs) was performed to evaluate the effect of follow up duration on effectiveness of aspiration thrombectomy. Methods: PubMed, Cochrane Library, EMBASE, Web of Science and CINAHL databases were searched through March, 2014. We included RCTs with acute myocardial infarction (AMI) patients randomized to aspiration thrombectomy prior to primary PCI compared with conventional primary PCI alone. Two individuals reviewed the trials for inclusion and extracted data from the RCTs. We used random-effects models. Results: Data were pooled from 16 RCTs with 11,649 patients. All-cause mortality was significantly lower with aspiration thrombectomy after at least 12 months of follow up (Odds ratio [OR] =0. 61; 95% CI 0.37-0.99; p=0. 05). Pooled data for other time frames, i.e in-hospital, 1 month, 6 month follow up, did not reach statistical significance. Conclusion: Beneficial effects of thrombus aspiration on mortality are not evident until 12 months post-procedure, consistent with the long-term effects of myocardial salvage. Subsequent trials evaluating thrombus removal should accordingly be powered for long-term mortality in addition to known procedural and angiographic endpoints.

scholarly journals Outcomes after thrombus aspiration for ST elevation myocardial infarction: 1-year follow-up of the prospective randomised TOTAL trial

The Lancet ◽  
2016 ◽  
Vol 387 (10014) ◽  
pp. 127-135 ◽  
Author(s):  
Sanjit S Jolly ◽  
John A Cairns ◽  
Salim Yusuf ◽  
Michael J Rokoss ◽  
Peggy Gao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
St Elevation Myocardial Infarction ◽  
Thrombus Aspiration ◽  
St Elevation ◽  
Total Trial

scholarly journals To Whom Thrombus Aspiration May Concern?

2019 ◽  
Vol 7 (11) ◽  
pp. 1774-1781
Author(s):  
Mohamed Samy ◽  
Yaser Nassar ◽  
Abo Hamila Mohamed ◽  
Walid Omar ◽  
Helmy Elgawaby
Keyword(s):  
Myocardial Perfusion ◽  
Conventional Group ◽  
Primary Pci ◽  
Thrombus Aspiration ◽  
Mean Values ◽  
Timi Score ◽  
St Segment ◽  
Direct Stenting ◽  
Stent Length

BACKGROUND: Thrombus aspiration for ST-segment elevation myocardial infarction (STEMI) may improve myocardial perfusion. However, these favourable results called into a question by data indicating not only a lack of efficacy but a risk of potentially deleterious complications.AIM: To assess the effect of thrombus aspiration during the primary percutaneous coronary intervention (PPCI) on procedural angiographic results, stent characteristics, and major adverse cardiac and cerebrovascular events (MACCE).METHODS: All consecutive STEMI patients candidate for PPCI and admitted to Critical Care Department, Cairo University hospitals, managed either by thrombectomy before primary PCI (if thrombus score ≥ 3) or conventional PPCI, Six hundred seven subjects were enrolled in the study divided into Group with thrombectomy before PPCI (107 subjects, 18%), and group with Conventional PCI (500 subjects, 82%). ST-segment resolution, peak CK-MB, TIMI score, thrombus score, and MBG were assessed; stent number, diameter, length and stented segment were reported and follow up MACCE was reported (in hospital and 1-year post-intervention).RESULTS: Mean values for peak CKMB were less in thrombectomy group (228 ± 174 I/U vs 269 ± 186 I/U, p = 0.04), ST segment resolution ≥ 70% occurred in {63 subjects (58.9%) vs 233 (46.6%), p = 0.001} in thrombectomy vs conventional group respectively. TIMI score pre procedure was zero in (102 subjects (95%) vs 402 (80.4%), p = 0.001), while TIMI III post procedure was reported in (100 subjects (93.4%) vs 437 (87%), p = 0.06), MBG mean values were (2.4 ± 0.6 vs 2.0 ± 1, p = 0.001), thrombus score was higher in thrombectomy group (4.6 ± 0.4 vs 0.8 ± 1.7, p = 0.001) in thrombectomy vs conventional group respectively .Direct stenting was { 34 patients (31%) vs 102 patients (20%), p = 0.05} , mean stent diameter (2.7 ± 1.3 mm vs 3.5 ± 1.3 mm, p = 0.3), mean stent length was (19.9 mm ± 10 versus 22.7 mm ± 8 in p 0.01). mean stent number was (1.0 ± 0.5 vs 1.2 ± 0.6, p = 0.001), mean stented segment was (22.5 ± 13.5 vs 28.5 ± 15.2 mm, p = 0.001) in thrombectomy vs conventional group respectively. MACCE in hospital were reported in {9 subjects (8.4%) vs 70 (14%), p = 0.07)}. Follow up MACCE after 1 year reported in {6 subjects (5.6 %) vs 80 (16 %), p 0.= 4} in thrombectomy vs conventional group respectively.CONCLUSION: Thrombus aspiration before primary PCI (in a selected group with thrombus score ≥ 3) improves myocardial perfusion, suggested by better ST-segment resolution, TIMI flow, less peak CKMB and MBG, associated with a higher rate of direct stenting, shorter stent length, stented segments and less number of stents. Although thrombus aspiration was done in more risky patients (higher thrombus score) MACCE (in hospital and 1 year follow up) showed no statistical difference.

scholarly journals Short-term outcome of Manual Thrombus Aspiration for patients Undergoing Primary PCI for Acute STEMI Showing LargeThrombus burden

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M N Penjameen ◽  
E M Elfekky ◽  
R R Elias ◽  
A I Nassar
Keyword(s):  
Systolic Function ◽  
P Value ◽  
Primary Pci ◽  
Thrombus Aspiration ◽  
Culprit Lesion ◽  
Short Term ◽  
St Segment ◽  
Group A ◽  
Group B

Abstract Background Thrombus aspiration (TA) might have a potential role in STEMI patients with heavy thrombus burden. The objective of several prospective trials whether routine TA in STEMI patients, contributes to a reduced mortality. After the first promising results, mainly based on the single center (TAPAS trial), results of the largest randomized trials to date (TASTE) study and (TOTAL) study, have not shown any significant differences in all-cause mortality, re-hospitalizations or stent thrombosis after a maximum of one-year follow-up period Objectives The aim of this prospective study is to study the in-hospital & short term out-come of using manual thrombus aspiration in STEMI patients undergoing primary PCI & showing large thrombus burden. Results The study included 209 patients referred to (CCU) of (Ain Shams University hospitals) with diagnosis of STEMI, who had under-gone primary PCI, with evidence of heavy thrombus burden . All the patients received DAPT, 99% had received GPIIbIIIa antagonists. The patients were divided into 2 groups: group (A) included 73 patients, who had under-gone manual thrombus aspiration followed by PCI to culprit lesion +/- other vessels & and group (B) included 136 patients, who had under-gone primary PCI of culprit lesion+/- other vessels, using the standard technique, without thrombus aspiration, within the period from 11/2016 till 7/2018(21 months),and they were followed up during hospital stay & for one month following hospital discharge. No stents were used in 13.7% of group (A), but no stents were used on 3.7% of group (B) (p value= 0.007). TIMI III flow had been achieved in 94.5% of group (A), 80.1% of group (B)(p value = (0.020) . MBG 3 had been achieved in 82.2% of group (A), 58.1% of group (B) . ST-segment resolution > 70% had been achieved in 8.2% of group (A), that hadnot been achieved in group (B) (p value =0.003). Mortality(among MACE) was the only event detected (p value 0.026). Follow up MACE were statisticalLy significant results (p value=0.022) . Statistically highly significant results regarding, LV systolic function EF %, p vaue= 0.001, had been achieved . Conclusion In STEMI patients with evidence of heavy thrombus burden, a strategy of manual aspiration thrombectomy is valuable in reducing index hospitalization mortality, and 1 month follow-up rates of mortality, TIMI flow, better MBG, ST-segment resolution, in addition to left ventricular systolic function .

scholarly journals Thrombus aspiration in hyperglycemic ST-elevation myocardial infarction (STEMI) patients: clinical outcomes at 1-year follow-up

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Celestino Sardu ◽  
Michelangela Barbieri ◽  
Maria Luisa Balestrieri ◽  
Mario Siniscalchi ◽  
Pasquale Paolisso ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Outcomes ◽  
St Elevation Myocardial Infarction ◽  
Thrombus Aspiration ◽  
St Elevation

scholarly journals Impact of thrombus aspiration in frail STEMI patients

2021 ◽  
Author(s):  
Pasquale Mone ◽  
Jessica Gambardella ◽  
Antonella Pansini ◽  
Mario Rizzo ◽  
Ciro Mauro ◽  
...  
Keyword(s):  
Coronary Intervention ◽  
Thrombus Aspiration ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
Frail Patients ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Risk Patients

Abstract Background Despite primary percutaneous coronary intervention (PPCI) is generally considered the best therapy in older frail adults with ST-segment elevation myocardial infarction (STEMI), the incidence of re-hospitalization for cardiovascular diseases remains significant in these patients. Aims We hypothesized that thrombus aspiration (TA) before PPCI could be a useful treatment for reducing mortality and rehospitalizations in frail patients undergoing PPCI for STEMI. Methods We conducted a study comparing PPCI alone vs TA + PPCI in frail STEMI patients. We examined a cohort of consecutive frail patients aged ≥ 65 years with first STEMI treated with PPCI between February 2008 and July 2015 at the Department of Cardiology of the “Cardarelli” Hospital in Naples, Italy. Results The study was completed by 389 patients (PPCI: 195, TA + PPCI: 194). At 1-month follow-up, the rate of death from any cause was 7.0% in patients treated with PPCI alone vs 3.0% in patients treated with TA + PPCI (p 0.036), whereas death from cardiovascular causes was 6.0% in the PPCI group vs 3.0% in the TA + PPCI group (p 0.028). Equally important, the rate of re-hospitalization due to heart failure was 7.5% in the PPCI group vs 4.0% in TA + PPCI group (p 0.025) and the rate of re-hospitalization due to acute coronary syndrome was 10.0% in the PPCI group vs 4.5% in the TA + PPCI group (p 0.016). Conclusion These results indicate the importance of TA in the treatment of STEMI in a group of high-risk patients such as elderly with frailty.

Outcome of AngioJet mechanical thrombus aspiration in the treatment of acute lower extremities deep venous thrombosis

Vascular ◽  
2020 ◽  
pp. 170853812095859
Author(s):  
Yingjiang Xu ◽  
Xuemin Wang ◽  
Dan Shang ◽  
Jianyong Liu ◽  
Wei Chen ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Baseline Data ◽  
Efficacy And Safety ◽  
Thrombus Aspiration ◽  
Bleeding Events ◽  
Thigh Circumference ◽  
Catheter Directed Thrombolysis

Objectives The objective of this study was to evaluate the efficacy and safety in patients with acute lower extremity deep venous thrombosis who underwent pharmacomechanical thrombectomy (PMT, AngioJet mechanical thrombus aspiration). Methods In this retrospective, 424 consecutive patients with acute lower extremity deep venous thrombosis from three institutions were enrolled in the study from January 2015 to December 2018. Of these, patients were divided into two groups, AngioJet group ( n = 186) and catheter-directed thrombolysis (CDT) group ( n = 238). Evaluation indexes including limb circumference difference, length of stay (LOS), urokinase dosage, periprocedural complications, follow-up imaging findings and villalta scores were analyzed from the medical records. Results A total of 424 patients diagnosed with acute lower extremity deep venous thrombosis were collected in this study. These patients were categorized into AngioJet group and CDT group. Significant differences were observed between the two groups with respect to the thigh circumference difference (5.32 ± 1.85 cm vs. 4.69 ± 2.15 cm; p = 0.04), calf circumference difference (2.79 ± 1.54 cm vs. 2.35 ± 1.25 cm; p = 0.01), thigh detumescence rate (72.19 ± 19.55% vs. 65.35 ± 17.26%; p = 0.00) and calf detumescence rate (62.79 ± 18.56% vs. 55.75 ± 17.27%; p = 0.00). The mean dose of urokinase in AngioJet group was 95.16 ± 45.89 million IU significantly less than that in the CDT group 293.76 ± 42.71 million IU ( p = 0.00). The overall bleeding complication rate was 9.91% (19 patients in AngioJet group and 23 patients in CDT group), which included three major (0.71%, 3/424) and 39 minor (9.2%,39/424) events. In the AngioJet group, serum creatinine (sCr) concentration and urine erythrocyte from the hemolysis caused by the mechanical process were higher than baseline data at admission ( p = 0.00, p = 0.00). The postoperative red blood cell and hemoglobin in two groups were lower than baseline data ( p = 0.00, p = 0.00). Compared with CDT, AngioJet thrombectomy has significantly lower estimated incidence of PTS in the follow-up. Conclusion AngioJet thrombectomy has stronger clearance ability for acute lower extremity deep venous thrombosis leading to significant reduction in the consumption of hospital resources, total dose of thrombolytic agents, and infusion time, thereby preventing adverse bleeding events, but patients with renal insufficiency should be careful. Ideal short-term and medium-term efficacy and safety are certain.

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