The amount of material retrieved by thrombus aspiration in patients referred for an Acute Coronary Syndrome is associated with their clinical and angiographic characteristics

Abstract

Thrombus aspiration (TA) may be useful to retrieve obstructive blood clot, restore coronary blood flow and prevent distal embolization in patients presenting an acute coronary syndrome. Although a cornerstone study has not demonstrated any benefit in hard clinical endpoints in a population of non-selected patients, TA is still being used in some cases by a number of interventional cardiologists. To determine if the amount of thrombotic material retrieved could be anticipated before TA. This monocentric, observational and retrospective study was carried out between December 2009 and September 2016. Patients were included in the study if after TA, material could be recovered for an anatomo-pathologic analysis. We present the macroscopic analysis of the study and compare demographic, clinical and angiographic characteristics of patients with thrombus ≥ 1 millimeter of length (TA+) or < 1 millimeter (TA−). This study included 79 patients (64 men), 54 in group TA+ (68%). As compared with TA−, patients TA+ were not significantly younger (60 years old vs. 63.4 years old; P = 0.39), had more often ST segment elevation myocardial infarction (STEMI) at presentation (90% versus 78%; P = 0.27) and more frequently single vessel disease (59% vs. 38%; P = 0.085). In 24 patients, TA was not followed immediately by stent implantation: 7 required stenting in a second procedure after a mean time of 6.8 days, the 17 others (22%) were not treated by stent implantation because of minor residual stenosis (8), coronary aneurysm (3), stent thrombosis and non-compliance with dual antiplatelet therapy (1), unspecified reason (3) and end stage cardiogenic shock (2), both died in the cath lab. The amount of material retrieved by TA may be predicted. Young patients with a STEMI and single vessel disease could be the best candidates. In some cases TA could prevent stent implantation. A dedicated study aiming this population would be of major interest.