Thrombus Aspiration during Primary Percutaneous Coronary Intervention

• Published in: The New England journal of medicine Vol. 358; no. 6; pp. 557 - 567
• Main Authors: Svilaas, Tone, Vlaar, Pieter J, van der Horst, Iwan C, Diercks, Gilles F.H, de Smet, Bart J.G.L, van den Heuvel, Ad F.M, Anthonio, Rutger L, Jessurun, Gillian A, Tan, Eng-Shiong, Suurmeijer, Albert J.H, Zijlstra, Felix
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 07-02-2008
• Subjects: Aged; Angioplasty, Balloon, Coronary - methods; Biological and medical sciences; Cardiac Catheterization - instrumentation; Cardiology; Coronary Angiography; Coronary Circulation; Coronary Thrombosis - diagnostic imaging; Coronary Thrombosis - pathology; Coronary Thrombosis - therapy; Diseases of the cardiovascular system; Electrocardiography; Female; General aspects; Heart attacks; Humans; Logistic Models; Male; Medical procedures; Medical sciences; Medical treatment; Microcirculation - pathology; Middle Aged; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Risk; Severity of Illness Index; Stents; Suction - adverse effects; Medicine; Angioplasty; Aspiration; Thrombus; Coronary artery; Primary; Instrumentation therapy; Cardiovascular disease; Coronary heart disease; Stent
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa0706416

Acute myocardial infarction with ST-segment elevation is treated with the use of percutaneous coronary intervention (PCI), but distal embolization of thrombotic material may limit the clinical efficacy of this procedure. In this study, aspiration of the thrombus during PCI improved reperfusion and clinical outcome. Thrombus aspiration appears to be a substantial advance in the treatment of acute myocardial infarction.
In this study, aspiration of the thrombus during percutaneous coronary intervention improved reperfusion and clinical outcome. Thrombus aspiration appears to be a substantial advance in the treatment of acute myocardial infarction.
Acute myocardial infarction with ST-segment elevation is caused by the rupture or erosion of an atherosclerotic plaque, initiating intraluminal thrombosis resulting in partial or complete occlusion of a coronary artery.
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Primary percutaneous coronary intervention (PCI) is the preferred treatment for myocardial infarction with ST-segment elevation and is effective in opening the infarct-related artery.
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However, microvascular obstruction with diminished myocardial perfusion occurs in a large proportion of patients with a patent epicardial vessel after primary PCI, and this event is associated with an increased infarct size, reduced recovery of ventricular function, and increased mortality.
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Microvascular obstruction is related . . .