Aspiration of thrombus makes sense – you present with an acute infarct, there’s plenty of soft thrombus blocking the artery – so you simply suck it out. It has become increasingly popular in the cardiology circle, however the evidence is variable. Some people think if you pull the thrombus out, surely you resolve ST segments earlier and prevent distal embolisation, but others say the device itself can push thrombus further down, not to mention delays time to definitive intervention.
This article from September’s New England Journal of Medicine randomised over 7,000 patients and found that routine thrombus aspiration before PCI, compared with PCI alone, did not reduce 30 day mortality among patients with STEMI. And now there’s this meta-analysis from JACC comparing all patients with acute myocardial infarction which did find a mortality benefit with aspiration (but not with mechanical thrombectomy).
It’s important to note that one of the markers of outcome used here is total ischaemic time – time of symptoms to time of device activation – and you’re going to see more and more of this as the key marker in STEMI, rather than simply door-to-balloon.
Great pair of articles, and there’s a nice editorial in JACC which goes through the data. Read the articles above and then check out the editorial here.
image | Wikimedia Commons