PT187 Bioresorbable scaffolds in the treatment of chronic total occlusions (CTO)

Abstract

Introduction: There is convincing evidence on the usefulness of manual thrombectomy in management of ST-elevation myocardial infarction. Experimental data obtained in vitro disclosed important differences in physicomechanical parameters required for effective thrombus aspiration with distinct aspiration catheters (AC). Direct in vitro comparison of several commercially available AC showed substantial differences in their trackability, pushability, and most of all, different volume of standardized saline solution or thrombus aspirated within a prespecified time unit. Objectives: The aim of the study was to assess the impact of different manual AC on immediate angioplasty results. For this purpose we have performed a stratified metaanalysis of randomized trials and reviewed the articles under several efficacy categories. Methods: From Medline and Cochrane Library we have idenified 11 randomized controlled trials with six different manual AC: Diver CE, Export, Eliminate, Pronto, Rescue, and Thrombuster. Results: Macroscopic thrombus was removed in 98.5% of cases in Eliminate group; 91% of cases in Diver CE group, 89% of cases in Pronto and Rescue groups, and 75.9% of patients in Export group. The use of thromboaspiration is better in achieving final TIMI III flow in comparison to PCI alone (OR 1.59 with 95% CI 1.16 – 2.19, p 1⁄40.004), however none of the aspiration catheter proved to be better than the others. The use of thromboaspiration is better in achieving final myocardial blush grade 3 in comparison to PCI alone (OR 1.94 with 95% CI 1.57 – 2.39, p 1⁄40.000) with best performance of Pronto (OR 9.48, p1⁄40,000), Diver (OR 2.57, p1⁄40.0058), Thrombuster (OR 2.33, p1⁄40.04), and Export (OR 1.77, p 1⁄40.000). The only aspiration catheter to prevent distal embolization is Pronto (OR 0.24, 95% CI 0.08 – 0.78, p1⁄40.0178). Thromboaspiration is better in achieving complete resolution of ST elevation in comparison to PCI alone (OR 1.42 with 95% CI 1.06 – 1.9, p 1⁄40.0179) and the only catheter to impact the complete ST resolution is Pronto (OR 2.08 with 95% CI 1.07-4.06, p1⁄40.031). Conclusion: This stratified metaanalysis shows Pronto aspiration catheter as most efficacious in restoring epicardial blood flow and myocardial perfusion in culprit vessel. However we must be cautious in interpreting this data as they are based on a single trial with Pronto aspiration catheter. The results of this metaanalysis are meant to be helpful in choosing the best aspiration catheter for everyday practice in STEMI patients. Disclosure of Interest: None Declared