Serdoz Roberta, Pighi Michele, Konstantinidis Nikolaos V, Kilic Ismail Dogu, Abou-Sherif Sara, Di Mario Carlo
National Institute for Health Research Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Sydney St, London, SW3 6NP, UK,
Curr Atheroscler Rep. 2014 Aug;16(8):431. doi: 10.1007/s11883-014-0431-3.
Mechanical reperfusion with primary percutaneous coronary intervention in acute ST-segment-elevation myocardial infarction is superior to fibrinolysis in terms of short-term and long-term outcome, provided that it can be delivered on time and by an experienced team. Balloon angioplasty and stent implantation of an occluded epicardial vessel during ST-segment-elevation myocardial infarction can cause disruption of the frail thrombus containing lesions associated with suboptimal myocardial reperfusion and microcirculatory obstruction. Distal embolization of atherothrombotic material can be prevented by thrombus aspiration during primary angioplasty. Mechanical aspiration via end-hole large-lumen thrombectomy catheters has been shown to improve Thrombolysis in Myocardial Infarction (TIMI) flow and result in a more consistent early resolution of ST-segment elevation in multiple registries. More recently, a more sophisticated quantification of the myocardial damage has been applied using myocardial scintigraphy and magnetic resonance, with no difference between patients treated with thrombectomy and patients treated with conventional therapy. The expectations in terms of lasting mortality benefit raised by the first Dutch single-center randomized trial of thrombectomy versus predilation with plain old balloon angioplasty (Thrombus Aspiration During Percutaneous Coronary Intervention in Acute Myocardial Infarction, TAPAS) were not confirmed by a much larger Swedish trial (Thrombus Aspiration ST-Segment Elevation Myocardial Infarction, TASTE) showing no outcome changes. Although we are waiting for new trials to clarify these controversial results, thrombectomy is still used in selected patients with high thrombus load or with persistent occlusion of the infarct-related artery after wire passage. Here we review the various systems available and discuss their relative merits and the reported results.
在急性ST段抬高型心肌梗死中，直接经皮冠状动脉介入治疗进行机械再灌注在短期和长期预后方面优于溶栓治疗，前提是能够及时由经验丰富的团队实施。在ST段抬高型心肌梗死期间，对闭塞的心外膜血管进行球囊血管成形术和支架植入，可能会破坏含有病变的脆弱血栓，导致心肌再灌注不理想和微循环障碍。在初次血管成形术期间通过血栓抽吸可预防动脉粥样硬化血栓物质的远端栓塞。在多个注册研究中，经端孔大腔血栓切除导管进行机械抽吸已被证明可改善心肌梗死溶栓（TIMI）血流，并使ST段抬高更早且更一致地消退。最近，已使用心肌闪烁显像和磁共振对心肌损伤进行更精确的量化，血栓切除术治疗的患者与传统治疗的患者之间无差异。荷兰第一项关于血栓切除术与普通球囊血管成形术预扩张对比的单中心随机试验（急性心肌梗死经皮冠状动脉介入治疗期间的血栓抽吸，TAPAS）所提出的关于持久死亡率获益的期望，未被一项规模大得多的瑞典试验（ST段抬高型心肌梗死的血栓抽吸，TASTE）证实，该试验显示结局无变化。尽管我们在等待新的试验来阐明这些有争议的结果，但血栓切除术仍用于血栓负荷高或导丝通过后梗死相关动脉持续闭塞的特定患者。在此，我们回顾现有的各种系统，并讨论它们的相对优点和报告的结果。
