Interventional Cardiology Unit, Cardiovascular Department, Misericordia Hospital, Via Senese 161, Grosseto, Italy
J Cardiovasc Med (Hagerstown). 2012 Jan;13(1):16-23. doi: 10.2459/JCM.0b013e32834becee.
The main goal of primary percutaneous coronary intervention (PPCI) is to achieve not only restoration of flow in the epicardial coronary artery, but also reperfusion at the level of myocardial tissue. Distal embolization is a possible complication of PPCI; in these patients, a microvascular injury occurs, which finally leads to a lack of myocardial reperfusion. Thrombus aspiration during PPCI has been proposed to prevent embolization. Several different thrombectomy devices have been demonstrated to be well tolerated and effective in improving surrogate markers of myocardial reperfusion; furthermore, in a few studies, the use of thrombectomy was associated with an improvement of clinical outcome. Because study results appeared largely inconsistent, especially about clinical outcome data, several meta-analyses have been carried out, showing that thrombectomy is able to improve markers of myocardial reperfusion and that manual thrombectomy is associated with better results in terms of myocardial reperfusion and clinical outcome, compared with embolic protection or mechanical thrombectomy devices, probably due to its easy and time-sparing use with low rate of complication. Literature data, based mainly on the Thrombus Aspiration During Primary Percutaneous Coronary Intervention (TAPAS) trial, indicate a favourable effect on outcome of routine manual thrombectomy strategy and the recent European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) guidelines on myocardial revascularization recommend thrombus aspiration during PPCI. However, data on long-term clinical outcome are still inconsistent and no trials have been, at the present time, designed to assess hard endpoint. In this review, we have carefully analysed literature data on thrombectomy during PPCI, taking into account the most recent studies and the last meta-analyses; study results have been compared to verify if either a routine or a selective use of thrombectomy should be adopted and to assess whether the use of thrombectomy may finally improve clinical outcome.
经皮冠状动脉介入治疗（PPCI）的主要目标不仅是实现心外膜冠状动脉的血流恢复，而且是心肌组织的再灌注。远端栓塞是 PPCI 的一种可能并发症；在这些患者中，发生微血管损伤，最终导致心肌再灌注不足。在 PPCI 期间进行血栓抽吸被提议用于预防栓塞。已经证明几种不同的血栓切除术装置在改善心肌再灌注的替代标志物方面具有良好的耐受性和有效性；此外，在一些研究中，使用血栓切除术与临床结果的改善相关。由于研究结果差异很大，特别是关于临床结果数据，因此进行了几项荟萃分析，结果表明血栓切除术能够改善心肌再灌注的标志物，并且与栓塞保护或机械血栓切除术装置相比，手动血栓切除术与更好的心肌再灌注和临床结果相关，这可能是由于其易于使用且耗时少，并发症发生率低。基于 Thrombus Aspiration During Primary Percutaneous Coronary Intervention (TAPAS) 试验的文献数据表明，常规手动血栓切除术策略对结果有有利影响，最近的欧洲心脏病学会 (ESC) 和欧洲心胸外科学会 (EACTS) 关于心肌血运重建的指南建议在 PPCI 期间进行血栓抽吸。然而，长期临床结果的数据仍然不一致，目前尚无试验旨在评估硬终点。在这篇综述中，我们仔细分析了 PPCI 期间血栓切除术的文献数据，考虑了最近的研究和最新的荟萃分析；比较了研究结果，以验证是否应采用常规或选择性使用血栓切除术，并评估血栓切除术是否最终可以改善临床结果。
