Department of Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands.
Catheter Cardiovasc Interv. 2012 May 1;79(6):860-7. doi: 10.1002/ccd.23214. Epub 2012 Jan 10.
In some patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutanous coronary intervention (pPCI) with thrombus aspiration, residual stenosis after thrombus aspiration is non-significant and additional balloon dilatation or stent placement may be unnecessary. We investigated the angiographic, procedural, and clinical outcomes of these patients in our single center pPCI-database. In addition, to gain insight in the pathological mechanisms of coronary thrombosis in these patients, we established the histopathological characteristics and age of the aspirated material.
This study consists of STEMI patients who underwent pPCI with thrombus aspiration alone in our institution. Thrombus material was collected and processed and the sections were analyzed for the presence of fresh (<1 day) or older thrombus (>1 day) and plaque components. One year clinical follow-up was obtained and vital status was assessed up to March 2010.
We identified 16 STEMI patients who underwent thrombus aspiration alone as the definitive treatment during pPCI. Acceptable flow with minimal non-significant residual stenosis immediately after thrombus aspiration was present in 14 patients (88%). In four patients (25%) repeat angiography was performed after several days and disappearance of the residual thrombus could be confirmed in three patients. During follow-up, repeat target lesion revascularization was performed in one patient at 53 days. No recurrent myocardial infarction was observed. Two patients died 1,166 and 1,228 days after the index-event from non-cardiac causes.
In selected STEMI patients undergoing pPCI, thrombus aspiration alone is feasible and safe on the short-term and there appears to be no high risk of recurrent ischemic events during follow-up. Our results suggest that additional balloon inflation or stent implantation may be unnecessary in selected patients, when there is no significant residual stenosis after thrombus aspiration.
在一些接受直接经皮冠状动脉介入治疗（pPCI）伴血栓抽吸的 ST 段抬高型心肌梗死（STEMI）患者中，抽吸后的残余狭窄无明显意义，可能不需要额外的球囊扩张或支架植入。我们在我们的单中心 pPCI 数据库中调查了这些患者的血管造影、程序和临床结局。此外，为了深入了解这些患者冠状动脉血栓形成的病理机制，我们建立了抽吸材料的组织病理学特征和年龄。
本研究包括在我们的机构中接受单独 pPCI 伴血栓抽吸的 STEMI 患者。收集血栓材料并进行处理，分析切片是否存在新鲜（<1 天）或陈旧（>1 天）血栓和斑块成分。获得了 1 年的临床随访，并在 2010 年 3 月前评估了生命状态。
我们确定了 16 例 STEMI 患者，他们在 pPCI 期间单独接受血栓抽吸作为明确治疗。14 例患者（88%）抽吸后即刻出现可接受的血流和最小的非显著残余狭窄。在 4 例患者（25%）几天后进行了重复血管造影，在 3 例患者中证实了残余血栓的消失。在随访期间，1 例患者在 53 天时进行了重复的靶病变血运重建。未观察到再发心肌梗死。2 例患者在指数事件后 1166 天和 1228 天因非心脏原因死亡。
在接受 pPCI 的选定 STEMI 患者中，单独血栓抽吸在短期是可行和安全的，在随访期间似乎没有再发缺血事件的高风险。我们的结果表明，在抽吸后无明显残余狭窄的情况下，对于某些患者，可能不需要额外的球囊扩张或支架植入。
