Thrombus Aspiration Research Articles

Therapeutic Efficacy of Tirofiban Combined With Thrombus Aspiration and Stent Thrombectomy in the Treatment of Large Vessel Occlusion Ischemic Stroke.

This research aimed to ascertain the effects of tirofiban combined with thrombus aspiration and stent thrombectomy on large vessel occlusion ischemic stroke (LVO-IS). Sixty patients with acute ischemic stroke (AIS) caused by LVO were randomized into the control group and the intervention group (n=30). Patients in the control group received thrombus aspiration combined with stent thrombectomy, while those in the intervention group were treated with tirofiban combined with thrombus aspiration and stent thrombectomy. General data, perioperative-related indicators, cerebral blood flow perfusion, coagulation function indicators, and neurological function indicators were collected, and the prognosis was observed after 3-month treatment. A comparison of symptomatic cerebral hemorrhage rate and hospital mortality rate between the 2 groups displayed no significant difference (P>0.05). The rate of revascularization in the intervention group (90.00%) was higher versus the control group (66.67%). After treatment, the mean blood flow and cerebral blood volume of the intervention group were higher and the time to peak cerebral blood flow was less versus the control group. The prothrombin time, activated partial thromboplastin time, and prothrombinogen time of the intervention group were higher, and fibrinogen was lower versus the control group. A lower National Institutes of Health Stroke Scale score was observed in the intervention group versus the control group. Tirofiban combined with thrombus aspiration and stent thrombectomy has good efficacy in LVO-IS patients.

Thrombus aspiration in primary percutaneous coronary intervention in acute ST-elevation myocardial infarction patients with high thrombus burden: one-year outcomes in a tertiary healthcare center in Ho Chi Minh City

Abstract Background Primary percutaneous coronary intervention (PCI) can dislodge atherosclerotic debris, risking microvascular embolism. Thrombus aspiration (TA) before stenting in ST-segment elevation myocardial infarction (STEMI) patients has been linked to reduced mortality, lower recurrence of heart attacks, and improved cardiac function. However, limited research exists on the effectiveness of TA in Vietnam, underscoring the need for further studies to enhance cardiovascular care. This prospective observational study was conducted to evaluate the role of TA in STEMI patients admitted with a substantial thrombus burden at Nguyen Tri Phuong Hospital. Results Out of 92 participants, 68 underwent TA treatment. Post-treatment, the TA group exhibited better TIMI and TMP flow grades and a higher rate of ST-segment normalization, with no significant difference in major adverse cardiac events (MACEs) at 30-day and 12-month follow-ups compared to those untreated. Conclusions TA during PCI enhances ST-segment normalization and TIMI and TMP scores in STEMI patients, improving myocardial perfusion. No difference in MACE occurrence was noted between groups after 30 days and 12 months, suggesting TA’s potential benefits without increasing adverse outcomes.

Комплексне оцінювання віддаленого прогнозу пацієнтів після перенесеного інфаркту міокарда з елевацією сегмента ST

The aim – to develop a validated scale for predicting long-term prognosis after ST-elevation myocardial infarction (STEMI), taking into account both clinical, laboratory, and instrumental parameters and the morphological features of intracoronary thrombi. Materials and methods. The study included 100 patients with STEMI aged 57.81 ± 10.26 years. They underwent primary percutaneous coronary intervention within 12 (7.00 [4.75; 10.00]) hours of the onset of the disease, which also included manual thrombus aspiration. Not only clinical, laboratory, or instrumental parameters were determined in patients, but also the morphological structure of intracoronary thrombi. The prognosis was assessed by the occurrence of one of the three events studied: death, myocardial infarction, and coronary revascularization. The duration of observation was two years.Results. The analysis included 24 clinical, anamnestic, laboratory, or instrumental parameters, as well as 5 morphologic signs of intracoronary thrombi. From the set of factors that were studied in the course of the work, three factors have been identified by the method of logistic regression, which, when combined, have an impact on the risk of developing the events. One factor has a preventive effect (layered thrombus structure), and two factors have a provocative effect (arterial hypertension, chronic kidney disease). The formula for calculating Z to determine the probability of the influence of the selected factors on the occurrence of the studied events is as follows: Z = - 3.35 - 1.08 . X1 + 2.58 . X2 + 1.37 . X3, where X1 is a layer structure (possible options are 1 or 0), X2 is arterial hypertension, and X3 is chronic kidney disease. The sensitivity of the model is 75.00 % and the specificity is 75.68 %. The total ratio of correctly predicted (positive and negative) cases is 75.56 %.Conclusions. A comprehensive determination of the prognosis of STEMI using a scale that includes clinical, anamnestic, laboratory, instrumental and morphological examinations may provide an additional means of risk stratification in such patients.

Coronary Angiographic Features of de Winter Syndrome: More Than Just Occlusion of the Left Anterior Descending Artery.

The de Winter electrocardiogram (ECG) pattern is a rare presentation of ST-segment elevation myocardial infarction (STEMI) equivalent. The clinical profile of de Winter syndrome remains to be clarified. Medical records of 1865 consecutive patients with acute myocardial infarction admitted from November 2018 to July 2023 were screened. Twelve patients (0.6%) with de Winter syndrome were included. STEMI patients whose culprit vessel was the left anterior descending artery (LAD) but without de Winter ECG pattern were selected as controls after 1:2 matching for age and sex. The de Winter syndrome patients were all male, aged 49.0 (46.3-52.5) years. The culprit lesion was the proximal LAD in seven patients (58.3%), the middle LAD in three (25%), the left main coronary artery in one (8.3%), and the ramus intermedius artery in the other. All of their culprit lesions had TIMI Thrombus Grade < 4, Cohen-Rentrop Score ≤ 2, and residual stenosis ≥ 80% after pretreatment with thrombus aspiration or balloon predilatation. Intracoronary imaging data were available in four patients, showing severe atherosclerotic stenosis. Compared with STEMI, de Winter syndrome had a higher prevalence of prior recurrent angina (75.0% vs. 37.5%, p = 0.034), better coronary collateralization (Cohen-Rentrop Score: 1 vs. 0, p = 0.001), lower thrombus burden (TIMI grade: 1 vs. 2, p = 0.005) but more severe atherosclerotic stenosis in the culprit lesions (90% vs. 60%, p < 0.001). The culprit lesions of de Winter syndrome have a low thrombus burden, severe atherosclerotic stenosis, and poor collateral circulation protection.

Thrombosis in Hemodialysis Tunnelled Central Venous Catheters: From Pathogenesis to Therapeutic Strategies

Central venous catheter-related thrombosis is a frequent non-infectious complication, typically associated with catheter dysfunction and hemodialysis inadequacy. Central venous catheters (CVCs) are categorized into non-tunnelled and tunnelled types, wherein the choice depends on patient's clinical conditions and the diagnostic and therapeutic workup. Tunnelled CVCs (tCVCs) are sought whenever an arteriovenous fistula is unfeasible or as primary access in patients with poor prognosis. Dysfunction is defined as the inability to maintain adequate blood flow within the prescribed dialytic session. Amongst non-infectious complications causing tCVC malfunctioning, thrombosis is the most frequent, and it is further classified into intrinsic (being endoluminal, pericatheter or fibrin sleeve-associated thrombosis) and extrinsic forms (including mural and atrial thrombosis). Diagnosis requires imaging tests like chest X-ray or abdominal X-ray, echocardiography, dynamic catheterography and computed tomography. Pharmacological treatment involves use of local thrombolytic agents. In case of extrinsic thrombosis, systemic anticoagulation is mandatory, occasionally requiring tCVC replacement. Prevention of thrombotic complications includes adequate positioning and appropriate use of the tCVC, with anticoagulant/antimicrobial-based locking solutions playing a crucial role in this context. In cases of extrinsic thrombosis, treatment options vary based on thrombus size, ranging from a conservative approach availing of systemic anticoagulation to surgical interventions like thrombectomy or thrombus aspiration, possibly associated with tCVC removal. In conclusion, late dysfunction of tCVCs is primarily due to thrombosis, thus requiring diagnostic imaging and specific drug therapies. Prevention is crucial to minimize complications.

Thrombus aspiration in ST elevation myocardial infarction: are we done?

Thrombus aspiration in ST elevation myocardial infarction: are we done?

Thrombus aspiration in people living with HIV- a night mare for interventionist

Abstract Background Cardiovascular disease, particularly atherosclerosis, and its complications are a growing cause of morbidity and mortality among individuals living with human immunodeficiency virus (HIV) in the post-antiretroviral therapy era. The role of thrombus aspiration combined with primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) within this population remains contentious. While PCI is the preferred strategy for immediate revascularization in acute STEMI, challenges persist, with about 30% of patients experiencing persistent chest pain and ST-segment elevation despite achieving TIMI III flow in the culprit vessel. Methods We conducted a prospective observational study spanning from January 2015 to September 2023, involving ten consecutive HIV-infected patients presenting with STEMI to our acute coronary care unit. The study encompassed an analysis of baseline clinical characteristics, response to fibrinolytic therapy, angiographic findings, thrombus aspiration using the Export Aspiration Catheter, and the outcomes of percutaneous coronary intervention (PCI). Patients were closely monitored for in-hospital outcomes and followed up for five years, during which they received adjuvant highly active antiretroviral therapy (HAART). Results The mean age of the patients was 46 years, lower than their uninfected counterparts. Most patients presented with a lower Killip class, indicating favorable outcomes. CD4 count distribution showed variability, with ten patients undergoing rescue angioplasty with thrombus aspiration using the Export Catheter. The cohort was followed for five years, receiving consistent HAART therapy. Conclusion HIV-associated atherosclerosis presents a considerable health burden, characterized by distinctive non-calcified and inflammatory plaques vulnerable to rupture. Thrombus aspiration during PCI emerged as a valuable strategy, reducing thrombotic burden and contributing to improved clinical outcomes in people living with HIV.

Platelet-large cell ratio predicts no-reflow in patients undergoing primary coronary angioplasty for ST-segment elevation myocardial infarction

Abstract Background Increased platelet indices have been shown to reflect higher degree of platelet activation and have been related to poorer short- and long-term outcomes in patients presenting with ST-segment elevation myocardial infarction (STEMI). Purpose We aimed to evaluate the ability of a validated marker of platelet activation (i.e., the platelet-large cell ratio [P-LCR]) to predict the occurrence of no-reflow in patients undergoing primary percutaneous coronary intervention (pPCI) for STEMI. The ability of P-LCR to predict other markers of thrombotic charge (i.e., use of glycoprotein IIb/IIIa inhibitors and/or thrombus aspiration) was also investigated. Methods Use of glycoprotein IIb/IIIa inhibitors and/or thrombus aspiration, occurrence of the ‘no-reflow’ phenomenon and P-LCR values on admission were recorded in 836 consecutive patients treated by pPCI for STEMI. Patients’ demographic data and symptom onset-to-cardiac catheterization laboratory time intervals were also recorded. Correlations between P-LCR values and the presence of thrombotic charge markers were evaluated. Results No-reflow occurred in 124 (14.8%) of the study patients; glycoprotein IIb/IIIa inhibitors and thrombus aspiration were used in 228 (27.3%) and in 289 (34.5%) of patients, respectively. Mean P-LCR values were 27.1 ± 7.6%. P-LCR values on admission were significantly higher in patients who presented no-reflow than in those who did not (29.1 ± 5.6% vs. 25.3 ± 5.8%, p = 0.03). Similarly, P-LCR were significantly higher in patients in whom glycoprotein IIb/IIIa inhibitors (29.5 ± 6.1% vs. 25.2 ± 5.3%, p = 0.04) and/or thrombus aspiration (28.4 ± 5.7% vs. 24.8 ± 5.4%, p = 0.03) were used. A P-LCR value ≥26.9% predicted the occurrence of no-reflow with 70.9% sensitivity and 55.4% specificity (p = 0.04). Conclusions In the present cohort, P-LCR values on admission predicted the presence of thrombotic charge markers in patients undergoing pPCI for STEMI. Evaluating P-LCR on admission could help identify patients at increased risk of no-reflow, in whom more intensive antiplatelet strategies may be of interest.

To evaluate coronary microvascular obstruction by myocardial contrast echocardiography and its influence on prognosis in patients with ST-segment elevation myocardial infarction

Abstract Background The goal of primary PCI (pPCI) is not only to restore epicardial coronary blood flow quickly but also to provide continuous myocardial tissue level reperfusion through coronary microcirculation. However, the incidence of coronary microvascular obstruction (MVO) after pPCI is as high as 50%-60%, which is closely related to the occurrence of heart failure and increased mortality of patients. Myocardial contrast echocardiography (MCE) is a new noninvasive technique for real-time observation of myocardial microcirculation perfusion in a specific imaging mode. At present, there are few studies on the application of MCE in the evaluation of coronary MVO in STEMI patients in China. Purpose To evaluate coronary MVO by MCE and its influencing factors and prognosis value after pPCI in patients with STEMI. Methods Patients with STEMI who received pPCI from October 2020 to June 2023 in the CCU were enrolled. MCE examination was performed on the 5th to 7th day after pPCI. The patients were divided into the MVO group and Non-MVO group. Major adverse cardiovascular events (MACE) were observed by 6-month follow-up after STEMI onset. Multiple Logistic regression analysis was used to analyze the risk factors for MVO, Multiple Cox regression analysis of the risk factors for MACE and Kaplan-Meier survival curve to compare the cumulative event-free survival of the two groups. Results A total of 98 patients were included in the analysis. The age was 59.88±11.71 years old, and 76(77.55%) were male. MCE examination showed 52 cases in the MVO group and 46 cases in the Non-MVO group. The incidence of MVO was 53.1% (52/98). There were 15 patients with MACE during follow-up. The results of stepwise Multivariate Logistic regression analysis showed that the peak value of cardiac troponin T (cTnT) (OR=1.354,95%CI 1.103-1.661, P=0.004) and without thrombus aspiration (TA) were independent risk factors for MVO (OR=5.588,95%CI 1.915-16.308, P=0.002). Multivariate Cox regression analysis indicated that female (HR=2.891, 95%CI 1.027-8.135, P=0.044), left ventricular ejection fraction (LVEF) &amp;lt;40% (HR=9.960, 95%CI 3.370-29.435, P&amp;lt;0.001) and MVO (HR=5.759,95%CI 1.279-25.935, P=0.023) were independent risk factors for MACE. Kaplan-Meier survival curve showed that the cumulative event-free survival rate in the Non-MVO group was higher than that in the MVO group, and the difference was statistically significant (P=0.0047). Conclusion The incidence of coronary MVO was higher in STEMI patients after pPCI, the peak value of cTnT and without TA were independent risk factors of MVO. The independent risk factors for MACE were female, LVEF &amp;lt; 40%, and MVO.

Association of Neutrophil extracellular traps burden with clinical and angiographic characteristics in patients with ST-elevation myocardial infarction

Abstract Background The precise triggers for arterial plaque rupture and the underlying pathophysiology of thrombogenesis remain elusive. Polymorphonuclear neutrophils (PMN), particularly their formation of Neutrophil Extracellular Traps (NETs), have garnered attention in the context of coronary atherothrombosis. This study sought to explore the association of NETs burden with clinical and angiographic characteristics in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI) and thrombus aspiration (TA). Methods This study included 336 consecutive STEMI patients undergoing pPCI and TA. Aspirated thrombi underwent histological analysis and NETs quantification via immunohistochemistry. Potential associations of clinical variables and angiographic outcomes with NETs burden were assessed. Results Manual TA was selectively performed in 72 cases with increased thrombotic burden and 60 thrombi were suitable for analysis. Most thrombi specimens displayed lytic features (63%) and almost three out of four specimens were identified as white thrombi. Increased NETs burden was significantly associated with prolonged pain-to-balloon time (&amp;gt;300 minutes) OR=10.29 (95% CI 2.11-42.22, p=0.001) and stress-induced hyperglycemia (SIH) OR=6.58 (95% CI 1.23-52.63, p=0.04) after multivariate regression analysis. Additionally, distal embolization (DE), a predictor of adverse outcomes, was more frequent among patients with an elevated NETs burden OR=16.9 (95% CI 4.23-44.52, p&amp;lt;0.001). Conversely, no significant association between NETs burden and final TIMI flow=3 was observed. Conclusion Elevated NETs burden in STEMI thrombi is linked to delayed reperfusion, SIH and increased risk of DE. Further research is needed to elucidate the role of NETs as a potential therapeutic target in acute atherothrombosis.

Assessment of microvascular occlusion in re-perfused myocardial infarction patients using cardiac magnetic resonance

Abstract Background and objective Primary percutaneous coronary intervention (PPCI) is the gold standard for myocardial reperfusion in ST-segment elevation myocardial infarction (STEMI). Numerous studies have shown that thrombus aspiration can prevent distal embolization, reducing the risk of microvascular obstruction (MVO). Cardiac magnetic resonance (CMR) is considered the gold standard for evaluation of MVO. The aim of this study is to evaluate the efficacy of thrombus aspiration as adjunctive technique to primary PCI, in reducing incidence and extent of MVO in STEMI patients evaluated by CMR. Methods Ninety-three patients with heavy thrombus burden were enrolled in this study, sixty-five met our inclusion criteria. Aspiration thrombectomy followed by PCI was done for thirty-one patients (aspiration group) and conventional PCI, without aspiration thrombectomy, was done for thirty-four patients (conventional group). Primary end points were occurrence and extent of microvascular obstruction (MVO) evaluated by cardiac magnetic resonance (CMR). Results The incidence of microvascular obstruction (MVO) was significantly higher in conventional group (18 patients, 52.9%) when compared with aspiration group (7 patients, 22.6%) (p-value = 0.012). Moreover, significant difference existed between studied groups as regard MVO extent. In aspiration group, MVO extended to &amp;gt; 4 segments in 3 patients (9.7%) while in conventional group, MVO extended to &amp;gt; 4 segments in 13 patients (38.2%) (p-value = 0.012). Conclusion Aspiration thrombectomy as adjunctive technique to PCI in STEMI population maintains the integrity of coronary microvasculature and reduces both incidence and extent of MVO.

Pulmonary artery pulsatility index evaluation in intermediate-to-high and high-risk pulmonary embolism patients underwent transcatheter intervention

Abstract Background The clinical impact of pulmonary embolism (PE) transcatheter intervention on the right ventricular function and its potential role as procedural outcomes has to be defined. Methods Consecutive patients who underwent pulmonary transcatheter intervention between 2021 and 2023 were included in an observational fashion. Data about clinical characteristics, PE risk stratification, pre and post-interventional pulmonary artery pressure (PAP) and Pulmonary Artery Pulsatility Index (PAPi) were collected. The primary endpoint was a composite of in-hospital death or repeated intervention. Results 49 patients were included, mostly female gender (61.2%), with a mean age of 67±12,9 years old, 79.6% with &amp;gt; 1 PE risk factor, and 55% of them stratified as high-risk (HR) PE. 34.6% of the patients were treated with transcatheter thrombolysis (all in the intermediate-to-high-risk cohort), 20% with FlowTriever device, 53.4% with Indigo Cath8 or Lightning 12 device, 8.1% of the procedure was performed under ECMO support. All patients classified in intermediate-to-high risk (IHR) survived, and the mean PAP was reduced (33.4±10.9 to 24.3±7.1 mmHg p&amp;lt;0.01), as well as PAPi (2,3±0.35 to 1.68±0.26 p&amp;lt;0.01). 22% of the patients In IHR experienced the primary endpoint, in these populations, the mean PAP (pre 33±4.1 vs post 30.5±4.6 p=0.58) and PAPi (pre 1.35±.0.6 vs post 1.4±0.6 p=0.39) did not change significantly. On the other side, those who survived without events had a slight significative reduction in mean PAP (pre 32±6.7 vs post 24.6±4.3 p&amp;lt;0.02) while the PAPi significantly increased (1.2±0.6 vs 1.8±0.2 p&amp;lt;0.01). In the HR population, a delta PAPi &amp;gt; 0.45 demonstrated a 65.7% sensitivity and 75% Specificity for the primary outcome AUC 0.83 at ROC curve analysis. Conclusion Pulmonary Thrombus aspiration significantly changes the PAP and PAPi in patients with acute PE. While in IHR patients the overperforming PAPi seems to normalize, in HR patients it increases and may be a marker of procedural success and right ventricle recovery.

Vital Predictive and Prognostic Roles of Triglyceride-Glucose Index in Women With Acute Myocardial Infarction: A Retrospective Cohort Study.

As a biomarker of insulin resistance (IR) in patients with acute myocardial infarction (AMI), the triglyceride-glucose index (TyG index) has received significant attention. However, most research on AMI has focused on male patients, as it is traditionally believed to primarily affect males. Therefore, this study was conducted on a female population with AMI to investigate the potential correlation between the TyG index and their outcomes. A total of 320 women who were admitted to Fujian Provincial Hospital for AMI between January 2017 and December 2019 were included in this study. The TyG index was calculated using the following formula: ln [fasting triglycerides (TG) (mg/dL) × fasting plasma glucose (FPG) (mg/dL)/2]. The primary endpoint of the study was the occurrence of major adverse cardiovascular and cerebrovascular events (MACCEs), which included all-cause mortality, myocardial infarction, repeat revascularization, rehospitalization for heart failure and stroke. The association between the TyG index and unfavorable outcomes in female patients was investigated using the Cox proportional hazards regression model. It was ultimately estimated that 111 patients developed MACCEs. Females with high TyG indices had a higher prevalence of diabetes, elevated heart rates, and hemoglobin A1c, as well as a higher likelihood of undergoing thrombus aspiration and stent placement. The TyG index was found to be positively correlated with the prevalence of hypertension, diabetes, low-density lipoprotein cholesterol, hemoglobin A1c, and damaged vessels. However, this correlation was modest, yet statistically significant. Furthermore, after adjusting for conventional risk factors, the TyG index (HR: 4.292, 95% CI: 2.784-6.616, p < 0.001) was independently associated with MACCEs. As an independent risk predictor, the TyG index has the potential to enhance clinical outcomes for women with AMI.

Evaluating the Impact and Financial Implications of Immediate versus Delayed Stenting Strategies in High Thrombus Burden Acute Myocardial Infarction: A Propensity Score-Matched Analysis.

The efficacy of delayed stenting strategies in the management of high thrombus burden acute myocardial infarction remains uncertain. We aimed to compare the therapeutic effects and financial implications of immediate and delayed stenting strategies in patients with acute myocardial infarction and high thrombus burden treated at our institution. This was a retrospective analysis of 158 patients who underwent intracoronary thrombus aspiration for acute ST-elevation myocardial infarction (STEMI) at the Second Affiliated Hospital of Shantou University Medical College between 2013 and 2023. Patients were divided into two groups: immediate stenting (immediate group; n = 101) and delayed stenting (delayed group; n = 57), based on the timing of the stenting procedure. Propensity score matching was performed to minimize confounding bias. Therapeutic effects and cost of treatment were compared between the two groups. After propensity score matching (n = 52 for each group), there were no significant differences in terms of baseline clinical characteristics, characteristics of vascular lesions (number of diseased vessels, culprit vessels, thrombolysis in myocardial infarction (TIMI) thrombus grade, proximal coronary artery lesion), the incidence of no-reflow/slow flow during the first surgery, or the use of antiplatelet drugs, intraprocedural anticoagulants, intracoronary drugs, and tirofiban. There were no significant between-group differences in terms of in-hospital all-cause mortality, in-hospital major adverse cardiovascular events, or hospitalization costs. However, peak creatine kinase-myocardial band (CK-MB) levels were significantly lower in the delayed group. For patients with STEMI undergoing emergency thrombus aspiration, a delayed stenting strategy appears to be non-inferior to immediate stenting strategy in terms of clinical efficacy and hospitalization costs, and may reduce the extent of myocardial injury. Delayed stenting strategy may allow for a more individualized surgical approach based on assessment of thrombus burden and lesion complexity.

Angiographic Outcomes in STEMI Patients: Evaluating Pre-dilatation and Thrombus Aspiration Effects

Introduction ST-elevation myocardial infarction (STEMI) poses significant challenges in cardiovascular care, necessitating rapid and effective reperfusion strategies. The present study assesses the angiographic outcomes of pre-dilatation and thrombus aspiration (PD+TA) versus conventional treatment without thrombus aspiration (NOTA) in patients undergoing PPCI for STEMI. Methods This prospective cohort study included a total of 155 patients, with 78 assigned to the PD+TA group and 77 to the NOTA group. Baseline demographics, cardiovascular risk factors, and angiographic assessments including TIMI flow, TMPG flow, corrected TIMI frame count (CTFC), ST segment changes, and ejection fraction were compared between the groups. Results The PD+TA group exhibited significantly lower systolic (p-value: 0.021) and diastolic blood pressures (p-value: 0.046), better glucose control (p-value: 0.015), and a more pronounced reduction in ST segment elevation (p-value: 0.027) compared to the NOTA group. Although ejection fraction at presentation was similar between groups, the PD+TA group (52.29±8.80%) demonstrated a statistically significant improvement at one-month follow-up from NOTA (49.14±8.20%). TIMI 3 and TMPG 3 flow rates were comparable between groups before and after drug administration, with significant improvements in CTFC observed in the PD+TA group. Conclusion Pre-dilatation and TA during PPCI for STEMI patients may lead to improved acute angiographic outcomes, including enhanced myocardial reperfusion and reduced ischemic burden. The significant improvement in ejection fraction at one-month follow-up further supports the potential benefits of PD+TA in cardiac function recovery. Larger studies with longer-term follow-up are needed to validate these findings and determine the broader clinical implications of TA in STEMI management. Clinical trial registration: CTRI/2019/02/017520, 7th February 2019, https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=Mjk5Mjc=&amp;Enc=&amp;userName=CTRI/2019/02/017520

Subacute in-stent thrombosis after carotid artery stenting in a patient with gene polymorphisms associated with aspirin and clopidogrel resistance: a case report

BackgroundCarotid artery stenting (CAS) is a key treatment option for moderate to severe carotid artery stenosis. Carotid stent thrombosis (CST), a rare complication of CAS, has gained significant attention because of its catastrophic nature. More evidences are needed to guide the diagnosis and treatment of CST.Case presentationThis study reports a rare case of sub-acute CST following CAS in a 50-year-old male patient who had experienced repeated cerebrovascular events on the premise of taking antiplatelet drugs. He also suffered an occlusion of the left middle cerebral artery (MCA) in the M2 segment, likely caused by an embolus detached from the stent thrombus. The cause of CST in this patient was presumed to be dual antiplatelet resistance (AR), as indicated by genetic testing. After treated with guide catheter-directed thrombolysis, thrombus aspiration, and a second round of thrombolysis, his in-stent thrombus was basically cleared. His M2 occlusion was resolved by mechanical thrombectomy using the Solitaire FR/Stent with Intermediate Catheter Assisting technique. The patient recovered well after replacement of antiplatelet drugs, and no new thromboembolic event occurred during the 13-month follow-up period.ConclusionsThe occurrence rate of AR-related CST may be underestimated as the cause of majority CST cases remains unclear. Implementation of genetic test for aspirin and clopidogrel resistance may be helpful to find the possible cause of CST and to avoid future repeated cerebrovascular events by replacement of antiplatelet drugs.

Value of Cardiac Magnetic Resonance Imaging in Assessment of the Myocardial Reperfusion after Primary Percutaneous Coronary Intervention with or without Thrombus Aspiration in Patients with ST-Elevation Myocardial Infarction with High Thrombus Burden

Abstract Background Primary percutaneous coronary intervention (PCI) is effective in opening the infarct related artery in patients with myocardial infarction with ST-segment elevation. However, the embolization of atherothrombotic debris induces microvascular obstruction and diminishes myocardial reperfusion. Objective The study aims to evaluate the efficacy and safety of the manual thrombus aspiration during primary PCI for the acute ST-elevation myocardial infarction (STEMI) patients with high thrombus burden. Patients and Methods The current study was prospective cohort study which was conducted on 100 patients presenting to cardiology department in Ain Shams University hospitals with STEMI in the first 12 hours of presentation, comparing two group (50 patients in each group): the thrombus aspiration group(group A) who underwent manual thrombus aspiration before the provisional stenting and the conventional PCI group (group B) who underwent provisional stenting using standard technique without thrombus aspiration.). every patient is assigned to a particular group based on the operator’s preference. The blood flow of the culprit coronary artery in the thrombolysis in myocardial infarction (TIMI) and the myocardial blush grade(MBG) was recorded immediately after the emergency PCI operation in each group, then an echocardiogram was performed to determine the left ventricular dimensions and ejection fraction within in 1 week after the operation, cardiac MRI was performed 3 months after the operation to determine the left ventricular dimensions, ejection fraction, stroke volume and size of infarction and finally the data on major adverse cardiovascular events (MACE) during the 6 months of postoperative follow-up were collected. Results There were no statistically significant differences between the two groups in terms of the demographic data, the cardiovascular risk factors, the vital data at the time of the hospital admission, the Killip class and the pain to door. The postoperative final TIMI flow was TIMI III flow in 46 patients (92%) of the thrombus aspiration group vs 34 patients (68%) in the conventional PCI group with P- value = 0.003 (statically highly significant). The final MBG was grade III in 40 patients (80%) of the thrombus aspiration group vs 30 patients (60 %) in the conventional PCI group, grade II in 10 patients (20 %) vs 16 patients (32%) and grade 0 only in 4 patients (4 %) in the conventional PCI group with P- value = 0.033 (statically significant). The post operative ECHO showed smaller Left ventricular dimensions with higher Left ventricular systolic and diastolic function in the thrombus aspiration group than the conventional PCI group with p value = 0.000 (statically highly significant). The postoperative cardiac MRI showed smaller Left ventricular end -systolic and end -diastolic volumes index with higher Left ventricular systolic function and Left ventricular Stroke volume index in the thrombus aspiration group than the conventional PCI group with p value = 0.000 (statically highly significant). Moreover, the postoperative cardiac MRI showed smaller LV Size of infarction (LV myocardia scar) in the thrombus aspiration group than the conventional PCI group with p value = 0.000 (statically highly significant).finally, there was a significant reduced rate of cardiovascular death and major adverse cardiovascular events (MACE) with no difference regarding the rate of the cerebrovascular stroke within 6 months post procedure in the thrombus aspiration group compared to the conventional PCI group with p value = 0.027 (statically significant).

Failed Thrombus Aspiration and Reduced Myocardial Perfusion in Patients With STEMI and Large Thrombus Burden

BackgroundThrombus aspiration (TA) is used to decrease large thrombus burden (LTB), but it can cause distal embolization. ObjectivesThe aim of this study was to investigate the impact of TA failure on defective myocardial perfusion in patients with ST-segment elevation myocardial infarction (STEMI) and LTB. MethodsIn total, 812 consecutive patients with STEMI and LTB (thrombus grade ≥3) were enrolled, who underwent manual TA during the primary percutaneous coronary intervention. TA failure was defined as the absence of thrombus retrieval, presence of prestenting thrombus residue, or distal embolization. The final TIMI flow grades and other myocardial perfusion parameters of the failed TA group were matched with those of the successful TA group. ResultsThe proportion of final TIMI flow grade 3 was lower (74.6% vs 82.2%; P = 0.011) in the failed TA group (n = 279 [34.4%]) than in the successful TA group (n = 533 [65.6%]). The failed TA group also had lower myocardial blush grade, lower ST-segment resolution, and a higher incidence of microvascular obstruction than the successful TA group. TA failure was independently associated with low final TIMI flow grade (risk ratio: 1.525; 95% CI: 1.048-2.218; P = 0.027). Old age, Killip class ≥III, vessel tortuosity, calcification, and a culprit vessel other than the left anterior descending coronary artery were associated with TA failure. ConclusionsTA failure is associated with reduced myocardial perfusion in patients with STEMI and LTB. Advanced age, hemodynamic instability, hostile coronary anatomy such as tortuosity or calcification, and non–left anterior descending coronary artery status might attenuate TA performance. (Gangwon PCI Prospective Registry [GWPCI]; NCT02038127)

Pharmacomechanical thrombectomy in management of pulmonary embolism

BackgroundAcute pulmonary embolism is recorded as one of the most common and critical medical conditions, resulting in a notable mortality rate requiring a multidisciplinary management. In this series, we address the management of massive and sub-massive pulmonary embolism utilizing catheter-based intervention, in particular the conjunction of mechanical thrombus disruption and aspiration with pharmacological thrombolysis (pharmacomechanical thrombectomy).Results37 patients were diagnosed with massive and sub-massive pulmonary embolism based on the clinical and radiological findings. Pre-procedural vital parameters were obtained, including oxygen saturation, pulse rate, and blood pressure. Under continuous monitoring and conscious sedation, a pulmonary angiography via right common femoral vein access was performed for pre-procedural assessment. Pharmacomechanical thrombectomy was performed using the AngioJet Ultra System (Boston Scientific). Using the power pulse option, a fibrinolytic agent was infused into the thrombus. After 5–10 min, mechanical thrombectomy is performed with a maximum 3 passes through the thrombus. This technique is performed in the main pulmonary artery and lower branch. The procedure is repeated on the other side. The maximum duration of thrombectomy is 2–3 min on each side. Procedure success was based on improvement of vital signs and not related to post-procedure angiographic findings. All patients showed immediate improvement of vital signs (blood pressure, 02 saturation, and pulse rate) with progressive improvement over the following days. There were no procedure-related complications.ConclusionPharmacomechanical thrombectomy is a safe and effective technique in the treatment of massive and submassive pulmonary embolism. It can be a first-line treatment even in patients without absolute contraindication to systemic thrombolysis.

Comparison of Angiographic Success and Clinical Outcomes Based on Different Percutaneous Coronary Intervention Techniques.

Introduction Primary percutaneous coronary intervention (PCI) is the standard treatment for patients with ST-segment elevation myocardial infarction (STEMI). Various PCI techniques exist, including balloon angioplasty, bare-metal stents (BMS), drug-eluting stents (DES), thrombus aspiration, direct stenting, rotational atherectomy (Rotablation), and cutting balloon angioplasty. Specific approaches for patients with STEMI and multivessel coronary artery disease may involve: 1) culprit vessel-only (CVO) primary PCI, 2) primary PCI followed by multivessel intervention of additional noninfarct lesions at the same procedure, or 3) CVO primary PCI followed by staged PCI of noninfarct lesions later during the index hospitalization or after discharge. However, their impact on angiographic success and clinical outcomes remains unclear. Methodology A retrospective study (n=90) evaluated the effectiveness of various PCI techniques during primary PCI. Data included demographics, clinical profiles, PCI strategies, and outcomes. Techniques such as thrombus aspiration, direct stenting, balloon angioplasty, and DES deployment were assessed. Descriptive statistics and chi-square tests were employed, with logistic regression for adjustment. Results The comparison of angiographic success and clinical outcomes based on different PCI strategies during primary PCI (n=90) revealed distinct differences. Successful procedures were associated with lower mean values for age (56.00 vs. 60.20), hypertension (165.50 vs. 170.30), weight (74.00 vs. 77.50), BMI, 26.80 vs. 28.70, KILLIP class (1.30 vs. 1.50), ejection fraction (45.80 vs. 47.90), creatinine (0.95 vs. 1.00), creatinine clearance (83.50 vs. 86.70), pulse rate (84.00 vs. 87.50), oxygen saturation (95.80 vs. 94.50), and blood sugar (170.00 vs. 182.00). Risk factors like hypertension (mean = 1.40 vs. 1.60), diabetes (mean = 1.60 vs. 1.70), and hyperlipidemia (mean = 1.85 vs. 1.95) also showed differences between successful and failed procedures. Significant variations were observed across PCI strategies for outcomes including angina within 30 days (Chi square = 18.75, p < 0.001), cerebrovascular accident (CVA, Chi square = 15.42, p = 0.001), acute left ventricular failure (LVF, Chi square = 12.67, p = 0.005), and cardiogenic shock (Chi square = 8.93, p = 0.029). Conclusion Patient demographics and clinical profiles influence PCI success. Techniques such as thrombus aspiration, direct stenting, balloon angioplasty, and DEShave varied impacts on clinical outcomes. While conventional balloon angioplasty remains a viable option, newer techniques such as DES and mechanical thrombectomy demonstrate superior angiographic success rates and improved clinical outcomes, particularly in complex lesion subsets. However, the selection of PCI technique should be guided by careful consideration of patient-specific factors, lesion characteristics, and procedural feasibility.