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World J Cardiol. Dec 26, 2015; 7(12): 889-894
Published online Dec 26, 2015. doi: 10.4330/wjc.v7.i12.889
Thrombus aspiration during primary percutaneous coronary intervention for acute myocardial infarction: A review of clinical evidence and guidelines
Muhammad Muzaffar Mahmood, Jonathan Watt, Javed M Ahmed
Muhammad Muzaffar Mahmood, Jonathan Watt, Javed M Ahmed, Cardiology Department, Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, United Kingdom
Author contributions: Mahmood MM performed the search and wrote the initial draft; Watt J and Ahmed JM reviewed the article and Ahmed JM is the guarantor of the content.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Javed M Ahmed, Consultant Cardiologist, Cardiology Department, Freeman Hospital, Freeman Road, Newcastle-upon-Tyne NE7 7DN, United Kingdom. javed.ahmed@nuth.nhs.uk
Telephone: +44-191-2137145 Fax: +44-191-2231175
Received: May 28, 2015
Peer-review started: June 1, 2015
First decision: June 18, 2015
Revised: October 4, 2015
Accepted: October 20, 2015
Article in press: October 27, 2015
Published online: December 26, 2015
Processing time: 210 Days and 10.7 Hours
Abstract

Acute ST segment elevation myocardial infarction (STEMI) is characterized by complete thrombotic occlusion of a major coronary artery. Early recanalization of the infarct-related artery is most efficiently delivered by primary percutaneous coronary intervention (PPCI), however this does not always restore normal myocardial perfusion, mainly due to distal embolization of the thrombus and microvascular obstruction. Early evidence for manual thrombus aspiration during PPCI was promising and this was once considered an important aspect of the procedure, especially in patients with a high thrombus burden. However, a large body of evidence from recent major randomized controlled trials (notably TASTE and TOTAL) does not support the routine use of manual thrombus aspiration in patients with STEMI undergoing PPCI.

Keywords: Primary percutaneous coronary intervention; Clinical evidence; Stroke; Acute myocardial infarction; Thrombus aspiration

Core tip: The role of manual thrombus aspiration during primary percutaneous coronary intervention (PPCI) for acute ST segment elevation myocardial infarction (STEMI) has been a matter of significant research and intense debate recently. The rationale for manual thrombus aspiration during PPCI is the removal of intracoronary thrombus, thus avoiding the complication of downstream embolization leading to impaired myocardial perfusion. In this review article, we present the data from early clinical trials and meta-analyses of thrombus aspiration during PPCI, and the more recent evidence from larger multi-center randomized controlled trials that have had a major influence on clinical practice. We highlight the relevant major society guidelines for thrombus aspiration during PPCI and provide the reader with an overview of this technology and its role in contemporary management of STEMI.