Alexopoulos Dimitrios, Davlouros Periklis A
Cardiology Department, Patras University Hospital, Rion 26504, Greece.
Curr Cardiol Rev. 2012 Aug;8(3):202-8. doi: 10.2174/157340312803217265.
Primary percutaneous coronary intervention, (pPCI), of native coronaries and saphenous vein grafts (SVGs), is the recommended reperfusion strategy for STEMI, and an early invasive approach is recommended for high risk patients with UA/NSTEMI. Although PCI effectively restores flow in the infarct related artery/culprit vessel in both situations, myocardial perfusion often remains suboptimal due to microvascular obstruction, partly attributed to distal embolization of thrombus. Hence, thrombectomy (manual or mechanical), prior to stenting may further reduce hard clinical end points in patients with ACS. This article discusses accumulated evidence regarding the safety and effectiveness of thrombectomy in culprit native coronaries and SVGs in such patients, as well as possible strategies for maximizing its benefits relative to the size of the thrombotic burden.
对自身冠状动脉和大隐静脉移植血管（SVG）进行的直接经皮冠状动脉介入治疗（pPCI）是ST段抬高型心肌梗死（STEMI）推荐的再灌注策略，对于高危不稳定型心绞痛/非ST段抬高型心肌梗死（UA/NSTEMI）患者推荐采用早期有创治疗方法。尽管在这两种情况下PCI都能有效恢复梗死相关动脉/罪犯血管的血流，但由于微血管阻塞，心肌灌注往往仍不理想，部分原因是血栓远端栓塞。因此，在支架置入前进行血栓切除术（手动或机械）可能会进一步降低急性冠状动脉综合征（ACS）患者的严重临床终点事件。本文讨论了有关此类患者在罪犯自身冠状动脉和SVG中进行血栓切除术的安全性和有效性的累积证据，以及相对于血栓负荷大小最大化其益处的可能策略。
