Talarico Giovanni Paolo, Burzotta Francesco, Trani Carlo, Porto Italo, Leone Antonio Maria, Niccoli Giampaolo, Coluccia Valentina, Schiavoni Giovanni, Crea Filippo
Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
J Invasive Cardiol. 2010 Oct;22(10):489-92.
The use of thrombus aspiration during percutaneous coronary intervention (PCI) is recommended in patients with ST-elevation myocardial infarction (STEMI) undergoing mechanical revascularization. When thrombus aspiration is adopted, the standard technique includes, after mechanical thrombus extraction, angioplasty and/or stent implantation to eliminate residual stenosis. To date, no data are available concerning the use of thrombectomy alone without additional ballooning or stenting.
We report the angiographic and clinical outcome of a series of selected STEMI patients undergoing mechanical reperfusion by thrombus aspiration without additional ballooning or stenting. Four patients out of 316 consecutive STEMI patients were managed by thrombus aspiration alone (1.3%). All patients had angiographic documentation of an occlusive large intracoronary thrombus in the infarct-related artery before intervention and complete restoration of coronary flow in the absence of critical coronary stenosis after thrombus aspiration. Three of these patients had a clinical contraindication to dual antiplatelet therapy, thus suggesting that to avoid stent implantation would be advisable. Angiographic reevaluation was performed before discharge in 3 patients confirming persistent patency of the infarct-related artery (in 1 case the residual stenosis was judged to require intravascular ultrasound evaluation and subsequent elective PCI with stent implantation). The thirty-day clinical course was uneventful in all patients.
In selected patients with STEMI undergoing mechanical reperfusion, thrombus aspiration without additional ballooning or stenting may be successfully performed. Further studies are needed to assess the clinical relevance of this novel approach.
对于接受机械血运重建的ST段抬高型心肌梗死（STEMI）患者，推荐在经皮冠状动脉介入治疗（PCI）期间使用血栓抽吸术。采用血栓抽吸术时，标准技术包括在机械性血栓清除后，进行血管成形术和/或支架植入以消除残余狭窄。迄今为止，尚无关于单独使用血栓切除术而不进行额外球囊扩张或支架植入的数据。
我们报告了一系列经血栓抽吸术进行机械再灌注且未进行额外球囊扩张或支架植入的STEMI患者的血管造影和临床结果。在316例连续的STEMI患者中，有4例（1.3%）仅接受了血栓抽吸术治疗。所有患者在干预前均有梗死相关动脉内闭塞性大冠状动脉血栓的血管造影记录，且在血栓抽吸后冠状动脉血流完全恢复，无严重冠状动脉狭窄。其中3例患者有双重抗血小板治疗的临床禁忌证，因此提示避免植入支架是可取的。3例患者在出院前进行了血管造影复查，证实梗死相关动脉持续通畅（1例患者的残余狭窄被判定需要进行血管内超声评估并随后择期进行支架植入的PCI）。所有患者的30天临床病程均平稳。
在接受机械再灌注的特定STEMI患者中，可成功进行不进行额外球囊扩张或支架植入的血栓抽吸术。需要进一步研究来评估这种新方法的临床相关性。
