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Contemporary Reviews in Interventional Cardiology

Thrombus Aspiration for ST-Segment–Elevation Myocardial Infarction in Modern Era

Still an Issue of Debate?

Junhua Ge, Andreas Schäfer, Georg Ertl, Peter Nordbeck
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https://doi.org/10.1161/CIRCINTERVENTIONS.117.005739
Circulation: Cardiovascular Interventions. 2017;10:e005739
Originally published October 17, 2017
Junhua Ge
From the Department of Cardiology, The Affiliated Hospital of Qingdao University, Shandong Province, China (J.G.); Department of Internal Medicine I (J.G., G.E., P.N.) and Comprehensive Heart Failure Center (J.G., G.E., P.N.), University Hospital Würzburg, Germany; and Department of Cardiology and Angiology, Hannover Medical School, Germany (A.S.).
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Andreas Schäfer
From the Department of Cardiology, The Affiliated Hospital of Qingdao University, Shandong Province, China (J.G.); Department of Internal Medicine I (J.G., G.E., P.N.) and Comprehensive Heart Failure Center (J.G., G.E., P.N.), University Hospital Würzburg, Germany; and Department of Cardiology and Angiology, Hannover Medical School, Germany (A.S.).
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Georg Ertl
From the Department of Cardiology, The Affiliated Hospital of Qingdao University, Shandong Province, China (J.G.); Department of Internal Medicine I (J.G., G.E., P.N.) and Comprehensive Heart Failure Center (J.G., G.E., P.N.), University Hospital Würzburg, Germany; and Department of Cardiology and Angiology, Hannover Medical School, Germany (A.S.).
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Peter Nordbeck
From the Department of Cardiology, The Affiliated Hospital of Qingdao University, Shandong Province, China (J.G.); Department of Internal Medicine I (J.G., G.E., P.N.) and Comprehensive Heart Failure Center (J.G., G.E., P.N.), University Hospital Würzburg, Germany; and Department of Cardiology and Angiology, Hannover Medical School, Germany (A.S.).
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    • Abstract
    • Commonly Used TA Devices
    • Potential Efficacy and Clinical Evidence for Positive Effects of TA in PPCI
    • Clinical Trials Not Showing Beneficial Effects of TA During PPCI
    • Reasons Potentially Responsible for the Divergent Results of TA During PPCI
    • Impact and Related Mechanisms of TA on Platelet Activation and Coagulation
    • Potential Mechanisms of Increased Incidence of Stroke Related to TA
    • Future Perspective
    • Disclosures
    • References
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Abstract

The role of manual thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) for acute ST-segment–elevation myocardial infarction has been a matter of intense research and debate now. Although recent randomized controlled clinical trials (notably TASTE [Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia] and TOTAL [Trial of Routine Aspiration Thrombectomy With PCI Versus PCI Alone in Patients With STEMI]) do not supply evidence supporting the routine use of TA in patients with ST-segment–elevation myocardial infarction, manual TA remains a therapeutic option for interventional cardiologists when treating patients with substantial thrombus burden during PPCI. It remains unknown whether patients might actually benefit from TA applied in a more selective manner depending on the thrombus burden during PPCI, instead of routine application. In this review, we summarize current knowledge on the instruments used in the TA procedure, positive as well as negative clinical effects of TA during PPCI, and analyze the potential reasons for observed effects, in an effort to help the clinical decision making by physicians for the use of TA in individual ST-segment–elevation myocardial infarction patients during PPCI.

  • clinical decision making
  • myocardial infarction
  • percutaneous coronary intervention
  • STEMI
  • thrombectomy
  • © 2017 American Heart Association, Inc.
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Circulation: Cardiovascular Interventions
October 2017, Volume 10, Issue 10
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  • Article
    • Abstract
    • Commonly Used TA Devices
    • Potential Efficacy and Clinical Evidence for Positive Effects of TA in PPCI
    • Clinical Trials Not Showing Beneficial Effects of TA During PPCI
    • Reasons Potentially Responsible for the Divergent Results of TA During PPCI
    • Impact and Related Mechanisms of TA on Platelet Activation and Coagulation
    • Potential Mechanisms of Increased Incidence of Stroke Related to TA
    • Future Perspective
    • Disclosures
    • References
  • Figures & Tables
  • Info & Metrics

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    Thrombus Aspiration for ST-Segment–Elevation Myocardial Infarction in Modern Era
    Junhua Ge, Andreas Schäfer, Georg Ertl and Peter Nordbeck
    Circulation: Cardiovascular Interventions. 2017;10:e005739, originally published October 17, 2017
    https://doi.org/10.1161/CIRCINTERVENTIONS.117.005739

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    Thrombus Aspiration for ST-Segment–Elevation Myocardial Infarction in Modern Era
    Junhua Ge, Andreas Schäfer, Georg Ertl and Peter Nordbeck
    Circulation: Cardiovascular Interventions. 2017;10:e005739, originally published October 17, 2017
    https://doi.org/10.1161/CIRCINTERVENTIONS.117.005739
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