Should Interventional Cardiologist use Aspiration Thrombectomy
Abstract
Shaimaa Mostafa, Vector Fadllaah
If there was a broken-down car on your street blocking traffic, would you rather hire a tow truck to remove it, or hire a bulldozer to smash it into smaller pieces? Asked Joshua Allen-Dicker [1]. Many randomized controlled trial examined whether removal of a coronary artery thrombus (the tow truck method) prior to stent placement improved 30 day mortality in STEMI patients as compared to placement of a stent without first removing the thrombus (the bulldozer method) [1]. In fact, this is a possible complication during primary PCI, resulting in microvascular obstruction and no-reflow phenomenon. The presence of a visible thrombus at the time of primary PCI in patients with STEMI is associated with poor procedural and clinical outcomes [2]. Physiologically, the tow truck method makes sense: removal of the thrombus prior to placing a stent should reduce distal embolization of thrombus fragments and improve overall myocardial recovery [1].