Thrombus Aspiration, from “Heart to Soul”

Open access

Abstract

Microvascular obstruction (MVO) is one of the most frequent complications encountered during primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction. The embolization of thrombotic material seems to be the leading cause of MVO, and many clinical trials have demonstrated that thrombus aspiration (TA) may be a useful means of preventing this phenomenon. Continuous advancements in technology have contributed to the development of various devices for thrombus aspiration. However, a review of the literature indicates that there is disagreement regarding the role of TA in the prevention and treatment of MVO. TA is increasingly used in the treatment of acute stroke in patients who are admitted to the hospital within eight hours from the onset of symptoms. This review presents the current knowledge regarding the role of TA in the prevention of MVO.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Le May MR Wells GA Glover CA et al. Primary percutaneous coronary angioplasty with and without eptifibatide in ST-segment elevation myocardial infarction: safety and efficacy study of integrilin-facilitated versus primary percutaneous coronary intervention in ST-segment elevation myocardial infarction (ASSIST). Circ Cardiovasc Interv. 2009;22:330-338. DOI: 10.1161/CIRCINTERVENTIONS.108.847582.108.847582

  • 2. Gu YL Kampinga MA Wieringa WG et al. Intracoronary versus intravenous administration of abciximab in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with thrombus aspiration: the comparison of intracoronary versus intravenous abciximab administration during emergency reperfusion of ST-segment elevation myocardial infarction (CICERO) trial. Circulation. 2010;122:2709-2717. DOI: 10.1161/CIRCULATIONAHA.110.002741

  • 3. Bertrand OF Rodés-Cabau J Larose MD et al. Intracoronary compared to intravenous abciximab and high-dose bolus compared to standard dose in patients with ST-segment elevation myocardial infarction undergoing transradial primary percutaneous coronary intervention: a two-by-two factorial placebo-controlled randomized study. Am J Cardiol. 2010;105:1520-1527. DOI: 10.1016/j.amjcard.2010.01.006.

  • 4. Thiele H Wöhrle J Hambrecht R et al. Intracoronary versus intravenous bolus abciximab during primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction: a randomised trial. Lancet. 2012;379:923-931. DOI: 10.1016/S0140-6736(11)61872-2

  • 5. Gibson CM Maehara A Lansky AJ et al. Rationale and design of the INFUSE-AMI study: a 2:2 factorial randomized multicenter single-blind evaluation of intracoronary abciximab infusion and aspiration thrombectomy in patients undergoing percutaneous coronary intervention for anterior ST-segment elevation myocardial infarction. Am Heart J. 2011;161:478-486.e7. DOI: 10.1016/j.ahj.2010.10.006

  • 6. Vlaar PJ Svilaas T van der Horst IC et al. Cardiac death and reinfarction after one year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): A 1-year follow-up study. Lancet. 2008;371:1915-1920. DOI: 10.1016/S0140-6736(08)60833-8.

  • 7. Steg PG James SK Atar D et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33:2569-2619. DOI: http://dx.doi.org/10.1093/eurheartj/ehs215

  • 8. O'Gara PT Kushner FG Ascheim DD et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127:529–555. DOI: 10.1161/CIR.0b013e3182742c84.

  • 9. Jolly SS Cairns JA Yusuf S et al. Randomized trial of primary PCI with or without routine manual thrombectomy. N Engl J Med. 2015;372:1389-1398. DOI: 10.1056/NEJMoa1415098

  • 10. Fröbert O Lagerqvist B Olivecrona GK et al. Thrombus aspiration during ST-segment elevation myocardial infarction. N Engl J Med. 2013;369:1587-97. DOI: 10.1056/NEJMoa1308789.

  • 11. Jolly SS Cairns JA Yusuf S et al. Stroke in the TOTAL trial: a randomized trial of routine thrombectomy vs. percutaneous coronary intervention alone in ST-elevation myocardial infarction. Eur Heart J. 2015;36:2364-2372. DOI: 10.1093/eurheartj/ehv296.

  • 12. Levine GN Bates ER Blankenship JC et al. 2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients with ST-Elevation Myocardial Infarction. J Am Coll Cardiol. 2016;67(10):1235-1250. DOI: 10.1161/CIR.0000000000000336

  • 13. Goto S Tamura N Ishida H. Ability of anti-glycoprotein IIb/IIIa agents to dissolve platelet thrombi formed on a collagen surface under blood flow conditions. J Am Coll Cardiol 2004;44:316-323. DOI:10.1016/j.jacc.2004.02.059.

  • 14. Speich HE Earhart AD Hill SN et al. Variability of platelet aggregate dispersal with glycoprotein IIb-IIIa antagonists: eptifibaide and abciximab. J Thromb Haemost 2009;7:983-991. DOI: 10.1111/j.1538-7836.2009.03432.x.

  • 15. Stone GW Maehara A Witzenbichler B et al. Intracoronary abciximab and aspiration thrombectomy in patients with large anterior myocardial. JAMA 2012;307:1817-1826.

  • 16. Iancu A Ober C Bondor CI Cadis H. Micro-vascular effect of intracoronary eptifibatide in acute myocardial infarction. Cardiology 2012;123:46-53.

  • 17. Stone GW Witzenbichler B Godlewski J et al. Intralesional abciximab and thrombus aspiration in patients with large anterior myocardial infarction: One-year results from the INFUSE-AMI trial. Circ Cardiovasc Interv. 2013;6(5):527-534. DOI: 10.1161/CIRCINTERVENTIONS.113.000644.

  • 18. Desch S Stiermaier T de Waha S et al. Thrombus aspiration in patients with ST-segment elevation myocardial infarction presenting late after symptom onset. J Am Coll Cardiol Intv. 2016;9:113-122. DOI: 10.1016/j.jcin.2015.09.010.

  • 19. Hara H Nakamura M Komatsu H et al. Comparison of the in vitro performance of 6 and 7 French aspiration catheters. EuroIntervention 2007;2(4):487-492.

  • 20. Virginie Pioud Luc Loris Bertrand Collinet al Coronary thrombectomy technical comparison of two systems on a laboratory bench: the impact of bends angles and thrombus age. EuroIntervention 2011;6:729-734. DOI: 10.4244/EIJV6I6A123.

  • 21. Pennati G Balossino R Dubini G Migliavacca F. Numerical simulation of thrombus aspiration in two realistic models of catheter tips. Artif Organs. 2010;34(4):301-310. DOI: 10.1111/j.1525-1594.2009.00770.x.

  • 22. Yan Li Rafiroiu D Iancu A et al. CFD analysis study on the impact of the coronary anatomy on the efficiency of the coronary thrombectomy: the effect of bend angles. Meditech 2011 IFMBE Proceedings 36:306-309.

  • 23. Sajjad Soleimani-Amiri. A study of coronary clot removal by means of aspiration actheters. PhD thesis Politecnico di Milano 2011

  • 24. Bhindi R Kajander OA Jolly SS et al. Culprit lesion thrombus burden after manual thrombectomy or percutaneous coronary intervention-alone in ST-segment elevation myocardial infarction: the optical coherence tomography sub-study of the TOTAL (ThrOmbecTomy versus PCI ALone) trial. Eur Heart J. 2015;36(29):1892-1900. DOI: 10.1093/eurheartj/ehv176.

  • 25. Stone GW Webb J Cox DA el al. Distal microcirculatory protection during percutaneous coronary intervention in acute ST-segment elevation myocardial infarction: a randomized controlled trial. JAMA. 2005;293(9):1063-1072.

  • 26. Kelbaek H Terkelsen CJ Helqvist S et al. Randomized comparison of distal protection versus conventional treatment in primary percutaneous coronary intervention: the drug elution and distal protection in ST-elevation myocardial infarction (DEDICATION) trialJ. J Am Coll Cardiol. 2008;51(9):899-905. DOI: 10.1016/j.jacc.2007.10.047.

  • 27. Stone GW Webb J Cox DA et al. Distal microcirculatory protection during percutaneous coronary intervention in acute ST-segment elevation myocardial infarction: a randomized controlled trial. JAMA. 2005;293:1063-72.

  • 28. Okamura A Ito H Iwakura K et al. Detection of embolic particles with the Doppler guide wire during coronary intervention in patients with acute myocardial infarction: efficacy of distal protection device. J Am Coll Cardiol. 2005;45:212-215.

  • 29. Kramer MC van der Wal AC Koch KT et al. Presence of older thrombus is an independent predictor of long-term mortality in patients with ST-elevation myocardial infarction treated with thrombus aspiration during primary percutaneous coronary intervention. Circulation. 2008;118(18):1810-1816. DOI: 10.1161/CIRCULATIONAHA.108.780734.

  • 30. Kramer MC Rittersma SH de Winter RJ et al. Relationship of Thrombus Healing to Underlying Plaque Morphology in Sudden Coronary Death. J Am Coll Cardiol. 2010;55:122-132. DOI: 10.1016/j.jacc.2009.09.007.

  • 31. De Maria GL Cuculi F Patel N et al. How does coronary stent implantation impact upon the status of the microcirculation during primary percutaneous coronary intervention in patients with ST elevation myocardial infarction? Eur Heart J. 2015;36:3165-3177. DOI: http://dx.doi.org/10.1093/eurheartj/ehv353

  • 32. Patel N Petraco R Dall'Armellina E et al. Zero-Flow Pressure Measured Immediately After Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction Provides the Best Invasive Index for Predicting the Extent of Myocardial Infarction at 6 Months: An OxAMI Study (Oxford Acute Myocardial Infarction). JACC Cardiovasc Interv. 2015;8(11):1410-1421. DOI: 10.1016/j.jcin.2015.04.029.

  • 33. Iancu AC Rafiroiu D Marc M. Is Coronary Wedge Pressure a Technique to Identify High-Risk Patients Who May Benefit From Alternative Treatment in Acute Myocardial Infarction? Is This The Next Step? J Am Coll Cardiol Intv. 2016;9(1):104-105. DOI:10.1016/j.jcin.2015.10.018

  • 34. Jovin TG Chamorro A Cobo E et al. Thrombectomy within 8 Hours after Symptom Onset in Ischemic Stroke. N Engl J Med. 2015;372:2296-2306. DOI: 10.1056/NEJMoa1503780

  • 35. Blankenship JC. The Oculothrombotic Reflex: Why We Will Never Stop Aspirating Coronary Thrombi. JACC Cardiovasc Interv. 2016;9(2):123-125. DOI: 10.1016/j.jcin.2015.10.026.

Search
Journal information
Metrics
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 197 61 3
PDF Downloads 125 41 2