Kotronias Rafail A, Walsh Jason L, Andreaggi Stefano, Portolan Leonardo, Maino Alessandro, Marin Federico, Chai Jason, Sobirov Ikboljon, Sheikh Muhammad, Cahill Thomas J, Lucking Andrew J, Costello Max, Fraile Moreno Eva, Haridas Vrinda, Shaji Anisha, Garcia-Garcia Hector M, Channon Keith M, Banning Adrian P, Langrish Jeremy P, De Maria Giovanni Luigi
Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom; Acute Multidisciplinary Imaging & Interventional Centre (AMIIC), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom.
Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom.
JACC Adv. 2025 Jun 23;4(7):101893. doi: 10.1016/j.jacadv.2025.101893.
Percutaneous coronary intervention (PCI) restores epicardial flow in ST-segment elevation myocardial infarction (STEMI), but large thrombus burden (LTB) can impair myocardial perfusion due to embolization. While manual aspiration (MA) devices have limited efficacy in STEMI, the success of stent-retriever thrombectomy (SRT) in stroke suggests it as a promising option for STEMI.
The RETRIEVE AMI (stent-retriever thrombectomy for thrombus burden reduction in patients with acute myocardial infarction) trial assessed the safety and efficacy of Solitaire X SRT vs Export MA in STEMI patients with LTB.
This single-center study enrolled 81 STEMI patients with LTB (TIMI thrombus grade ≥4) and randomized them to PCI, MA-assisted, or SRT-assisted PCI. The primary endpoint was difference in prestent thrombus volume by optical coherence tomography between SRT and either comparator; coprimary endpoints included device-related target vessel complications and major adverse cardiac and cerebrovascular events through 6 months.
SRT was performed in 26 cases (one crossover), and MA in 27. No device-related arterial complications or cerebrovascular events occurred in the SRT arm. Baseline thrombus volume was significantly higher in the SRT group (18.3 mm) compared to MA (7.7 mm) and no modification (9.8 mm; P = 0.04). Prestent thrombus volume was not significantly different between SRT (7.7; IQR: 2.3-18.6) and either MA (4.8; IQR: 1.8-8.4; P = 0.17) or no thrombus modification (9.8; IQR: 4.5-18.1; P = 1.00). Both techniques significantly reduced prestent thrombus burden (SRT: 12.8%; IQR: 4.4%-21.5%; P = 0.016 and MA: 13.0%; IQR: 3.8%-19.4%; P = 0.003) compared to no modification (22.8%; IQR: 10.4%-27.7%). No device-related clinically relevant arterial injury was detected and in-hospital and 6-month major adverse cardiac and cerebrovascular events did not differ between arms.
RETRIEVE AMI demonstrates the feasibility of Solitaire X SRT in STEMI with LTB. Prestent thrombus volume was not different between SRT, MA, or no thrombus modification, although SRT extracted larger thrombus volume than MA. Larger multicenter studies using optical coherence tomography-based criteria are needed to minimize variability and enhance comparative assessments.
经皮冠状动脉介入治疗（PCI）可恢复ST段抬高型心肌梗死（STEMI）患者的心外膜血流，但大量血栓负荷（LTB）可因栓塞而损害心肌灌注。虽然手动抽吸（MA）装置在STEMI中的疗效有限，但支架取栓器血栓切除术（SRT）在卒中治疗中的成功表明其可能是STEMI的一个有前景的选择。
RETRIEVE AMI（急性心肌梗死患者使用支架取栓器血栓切除术减轻血栓负荷）试验评估了Solitaire X SRT与Export MA在有LTB的STEMI患者中的安全性和疗效。
这项单中心研究纳入了81例有LTB（心肌梗死溶栓试验（TIMI）血栓分级≥4）的STEMI患者，并将他们随机分为PCI组、MA辅助组或SRT辅助PCI组。主要终点是SRT与任一对照之间通过光学相干断层扫描测得的支架置入前血栓体积差异；共同主要终点包括与器械相关的靶血管并发症以及6个月内的主要不良心脑血管事件。
26例患者接受了SRT（1例交叉），27例接受了MA。SRT组未发生与器械相关的动脉并发症或脑血管事件。与MA组（7.7mm）和未处理组（9.8mm）相比，SRT组的基线血栓体积显著更高（18.3mm；P = 0.04）。SRT组（7.7；四分位间距：2.3 - 18.6）与MA组（4.8；四分位间距：1.8 - 8.4；P = 0.17）或未处理血栓组（9.8；四分位间距：4.5 - 18.1；P = 1.00）之间的支架置入前血栓体积无显著差异。与未处理组（22.8%；四分位间距：10.4% - 27.7%）相比，两种技术均显著降低了支架置入前血栓负荷（SRT组：12.8%；四分位间距：4.4% - 21.5%；P = 0.016；MA组：13.0%；四分位间距：3.8% - 19.4%；P = 0.003）。未检测到与器械相关的临床相关动脉损伤，各治疗组之间的院内及6个月主要不良心脑血管事件无差异。
RETRIEVE AMI证明了Solitaire X SRT在有LTB的STEMI患者中的可行性。虽然SRT取出的血栓体积比MA大，但SRT组、MA组或未处理血栓组之间的支架置入前血栓体积无差异。需要开展更大规模的基于光学相干断层扫描标准的多中心研究，以尽量减少变异性并加强对比评估。
