Thrombectomy during PCI for acute myocardial infarction: are the randomized controlled trial data relevant to the patients who really need this technique?

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
David AntoniucciAngela Migliorini

Abstract

Macro and microembolization during percutaneous coronary intervention (PCI) in ST elevation acute myocardial infarction (STEAMI) is frequent and may result in obstruction of the microvascular network with subsequent reduction in efficacy of reperfusion. Numerous mechanistic studies have shown that the presence and size of the culprit thrombus is the most powerful predictor of incidence of embolization and slow flow/no reflow. Techniques that have been used to reduce the incidence of these events include thrombectomy devices and embolic protection devices. Although numerous prospective randomized clinical trials have been performed to evaluate the role of thrombectomy devices in patients with STEAMI, the results of these trials are conflicting and they speak to both sides of the controversy. The Achilles heal of the majority of these trials is the premise that thrombectomy devices should be routinely used in all patients presenting with STEAMI even irrespective of the presence and size of the thrombus. Such a hypothesis is naively optimistic and it ignores the basic knowledge available to us regarding the relationship between thrombus burden and embolization. Nonetheless, clinicians are faced every day with the reality of making...Continue Reading

References

Oct 18, 2003·Journal of the American College of Cardiology·Massimo NapodanoBernhard Reimers
Mar 27, 2007·International Journal of Cardiology·Francesco BurzottaFilippo Crea

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Citations

Nov 7, 2015·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Sarah A DayMegan A Rech
Aug 7, 2010·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Sarah A Spinler
Jan 15, 2011·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Michał CiszewskiWitold Rużyłło
Jan 29, 2016·Heart·David M Shavelle

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