Use Of Aspiration Thrombectomy Research Articles

An Integrated Approach to the Treatment of Pulmonary Embolism: Current State of the Problem


 The aim. Treatment of venous thromboembolism remains perhaps the most challenging problem of modern phlebology. The aim of our study was to analyze current data and guidelines on the use of surgical and minimally invasive approaches in the treatment of pulmonary embolism (PE) and to compare these with our own results.
 Materials and methods. The results of treatment of 168 patients with PE, who underwent inpatient treatment at the clinic from 2009 to 2021, were analyzed. Among them, 162 (96%) patients had deep vein thrombosis, in 6 patients the cause of PE could not be identified. Recurrent PE was observed in 2 patients. PE with a high risk of death was observed in 51 (30.3%) patients, with a medium and low risk of death in 117 patients (69.6%).
 Systemic thrombolysis was performed in 44 (26%) cases. In 5 (2.9%) cases, vena cava filters were implanted. One (0.6%) patient underwent aspiration thrombectomy of the pulmonary artery using an Aspirex catheter. Two (1.1%) patients underwent pulmonary artery thrombectomy using an artificial circulation device.
 Results. Significant improvement in patients treated with thrombolytic therapy was observed in 40 (92.8%) cases. After surgical treatment of PE, significant improvement was observed in 100% of cases, 2 patients after PE showed complete de-obstruction of the pulmonary artery. No hemorrhagic complications were observed during the study period. No fatalities were reported. No recurrent PE was observed during the study period.
 Conclusions. The choice of treatment for PE is determined by the degree of the impact on the pulmonary tract, the stability of the patient’s condition, indicators of dysfunction of the right heart, the period from the onset of the disease, the risk of death.
 The use of aspiration thrombectomy using an Aspirex catheter (Straub, USA) and pulmonary artery embolectomy in the absence of thrombolytic therapy allows to obtain satisfactory results in patients with PE.

Acute embolic stroke with large-vessel occlusion: does contact aspiration thrombectomy show superiority?

To compare the efficacy between contact aspiration thrombectomy and stent retriever thrombectomy in the treatment of acute embolic stroke patients with large vessel occlusion. Between January 2019 and June 2020, data from consecutive acute ischaemic stroke patients who underwent either endovascular contact aspiration or stent retriever thrombectomy were analysed at one institution. The primary outcome was the full 90-day modified Rankin Scale (mRS) score. Ordinal logistic regression analysis was used to assess the association between thrombectomy approach and functional outcomes. A total of 156 patients were analysed. Among them, 57 (36.5%) patients underwent primary aspiration thrombectomy, while 99 (63.5%) patients underwent primary stent retriever thrombectomy. The median procedure time was significantly shorter in patients treated with aspiration (37 versus 56 minutes; p<0.001). Compared with those of patients who underwent stent retriever thrombectomy, successful recanalisation rates and favourable functional outcome rates were higher in patients who underwent the aspiration approach (94.7% versus 77.8%, p=0.006; 49.1% versus 27.3%, p=0.006, respectively). Ordinal logistic regression analysis showed that aspiration thrombectomy was independently associated with a good functional outcome (adjusted common odds ratio, 0.30, 95% confidence interval: 0.16-0.60, p<0.001). Among the specific patients with large vessel occlusion in acute embolic stroke, the use of aspiration thrombectomy compared with stent retriever thrombectomy resulted in a greater likelihood of favourable neurological outcomes; however, because of study limitations, these findings should be interpreted as preliminary and require further study to confirm these results.

Safety and efficacy of aspiration thrombectomy versus stent retriever thrombectomy for acute ischaemic stroke: a systematic review and meta-analysis.

Although aspiration thrombectomy has shown comparable safety and efficacy to stent retriever thrombectomy for acute ischaemic stroke (AIS), the use of aspiration thrombectomy as first-line endovascular treatment for AIS remains controversial. To perform a systematic evaluation of the safety and efficacy of aspiration thrombectomy versus stent retriever thrombectomy in the treatment of AIS. We searched the online databases PubMed, Embase, Cochrane Library, and SinoMed to collect randomized controlled trials and retrospective studies concerning the treatment of AIS with aspiration thrombectomy and stent retriever thrombectomy. Primary outcomes included 90-day all-cause mortality, a 90-day mRS scores of 0-2, intracranial haemorrhage, and successful recanalization rate. The Jadad scale and the MINORS evaluation items were used to evaluate study quality, and RevMan 5.2 was used to conduct a meta-analysis. Any differential effects in rates between the two strategies were assessed using a random effect model. A total of 15 articles were found, including 2 randomized controlled trials and 13 retrospective studies. It showed that aspiration thrombectomy and stent retriever thrombectomy had similar results in terms of 90-day all-cause mortality (p = 0.88), 90-day mRS scores 0-2 (p = 0.29), and intracranial haemorrhage (p = 0.47). And in terms of successful recanalization rates, the aspiration thrombectomy group had better outcomes than the stent retriever thrombectomy group (p = 0.0003). The heterogeneity of 90-day all-cause mortality (I2 = 0%), 90-day mRS scores of 0-2 (I2 = 6%), intracranial haemorrhage (I2 = 21%), and successful recanalization rate (I2 = 0%) were less than 30%. Both aspiration thrombectomy and stent thrombectomy can be used as the first line of intravascular treatment for AIS.

Trends and Clinical Outcomes in Patients Undergoing Primary Percutaneous Revascularisation for ST-Elevation Myocardial Infarction: A Single Centre Experience

Primary percutaneous coronary intervention (PPCI) is the preferred therapy for patients presenting with ST-elevation myocardial infarction (STEMI). We reviewed patients undergoing PCI for STEMI over a 6-year period to evaluate changes in procedural characteristics and clinical outcomes given recent changes to STEMI guidelines. All patients presenting to the Alfred Hospital, a tertiary referral hospital, between 1 January 2010 and 31 December 2015 undergoing PCI for STEMI were identified. Detailed review of their procedure reports was performed and 30-day and 12-month clinical outcomes were recorded including major adverse cardiac events (MACE). There was a total of 445 patients aged 60.6±12.4 years with 369 (82.9%) male. There was a significant increase in radial access use over the 6-year period 0/49 (0%) in 2010 vs 56/113 (49.6%) in 2015 (p<0.01). There was a significant reduction in the use of IIb/IIIa receptor antagonists during the period 29/49 (59%) in 2010 vs 24/113 (21%) in 2015 (p<0.01) and use of aspiration thrombectomy 15/49 (31%) in 2010 vs 19/113 (17%) in 2015 (p<0.01). There was no significant reduction in major bleeding over this period with 2/49 (4%) in 2010 vs 5/108 (5%) in 2015 (p=0.32). Thirty-day and 12-month mortality was also unchanged. Between 2010 and 2015 there has been a significant increase in the use of radial access and a reduction in the use of glycoprotein IIb/IIIa antagonists and aspiration thrombectomy in patients undergoing PPCI. This was not associated with changes in major bleeding or 30-day or 12-month mortality.

Trends in primary angioplasty in Portugal from 2002 to 2013 according to the Portuguese National Registry of Interventional Cardiology

Introduction and ObjectivesThe aim of the present paper was to report trends in coronary angioplasty for the treatment of ST-elevation myocardial infarction (STEMI) in Portugal. MethodsProspective multicenter data from the Portuguese National Registry of Interventional Cardiology (RNCI) and official data from the Directorate-General for Health (DGS) were studied to analyze percutaneous coronary intervention (PCI) procedures for STEMI from 2002 to 2013. ResultsIn 2013, 3524 primary percutaneous coronary intervention (p-PCI) procedures were performed (25% of all procedures), an increase of 315% in comparison to 2002 (16% of all interventions). Between 2002 and 2013 the rate increased from 106 to 338 p-PCIs per million population per year. Rescue angioplasty decreased from 70.7% in 2002 to 2% in 2013. During this period, the use of drug-eluting stents grew from 9.9% to 69.5%. After 2008, the use of aspiration thrombectomy increased, reaching 46.7% in 2013. Glycoprotein IIb-IIIa inhibitor use decreased from 73.2% in 2002 to 23.6% in the last year of the study. Use of a radial approach increased steadily from 8.3% in 2008 to 54.6% in 2013. ConclusionDuring the reporting period there was a three-fold increase in primary angioplasty rates per million population. Rescue angioplasty has been overtaken by p-PCI as the predominant procedure since 2006. New trends in the treatment of STEMI were observed, notably the use of drug-eluting stents and radial access as the predominant approach.

Angioplastia primária em Portugal entre 2002‐2013. Atividade segundo o Registo Nacional de Cardiologia de Intervenção

Introduction and ObjectivesThe aim of the present paper was to report trends in coronary angioplasty for the treatment of ST‐elevation myocardial infarction (STEMI) in Portugal. MethodsProspective multicenter data from the Portuguese National Registry of Interventional Cardiology (RNCI) and official data from the Directorate‐General for Health (DGS) were studied to analyze percutaneous coronary intervention (PCI) procedures for STEMI from 2002 to 2013. ResultsIn 2013, 3524 primary percutaneous coronary intervention (p‐PCI) procedures were performed (25% of all procedures), an increase of 315% in comparison to 2002 (16% of all interventions). Between 2002 and 2013 the rate increased from 106 to 338 p‐PCIs per million population per year. Rescue angioplasty decreased from 70.7% in 2002 to 2% in 2013. During this period, the use of drug‐eluting stents grew from 9.9% to 69.5%. After 2008, the use of aspiration thrombectomy increased, reaching 46.7% in 2013. Glycoprotein IIb‐IIIa inhibitor use decreased from 73.2% in 2002 to 23.6% in the last year of the study. Use of a radial approach increased steadily from 8.3% in 2008 to 54.6% in 2013. ConclusionDuring the reporting period there was a three‐fold increase in primary angioplasty rates per million population. Rescue angioplasty has been overtaken by p‐PCI as the predominant procedure since 2006. New trends in the treatment of STEMI were observed, notably the use of drug‐eluting stents and radial access as the predominant approach.

Meta-analysis of randomized controlled trials comparing percutaneous coronary intervention with aspiration thrombectomy Vs. Conventional percutaneous coronary intervention during ST-segment elevation myocardial infarction.

Evaluate the impact of aspiration thrombectomy (AT) during primary coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) on clinical outcomes. AT during PCI for STEMI may improve microvascular reperfusion, but its impact on clinical outcomes has remained controversial. We searched Pubmed, EMBASE, Medline, Scopus, CENTRAL, andClinicalTrials.gov databases on March 31, 2015 for randomized controlled trials that evaluated the use of AT with PCI compared with PCI alone for STEMI. The primary end point was all-cause mortality. Secondary end points included major adverse cardiac events (MACE, consisting of death, myocardial infarction, and target-vessel revascularization), recurrent myocardial infarction (MI), target-vessel revascularization (TVR), stent thrombosis and stroke. Eighteen randomized controlled trials (n = 21,501) fulfilled the inclusion criteria. A total of 10,544 patients were treated with AT and PCI, compared to 10,957 control patients. The use of AT was not associated with a significant decrease in all-cause mortality (RR 0.88; 95% CI 0.78-1.01; P = 0.07), MACE (RR 0.93; 95% CI 0.86-1.00; P = 0.06), recurrent MI (RR 0.97: 95% CI 0.81-1.17; P = 0.77), TVR (RR 0.93; 95% CI 0.82-1.05; P = 0.23), stent thrombosis (RR 0.84; 95% CI 0.66-1.07; P = 0.17), or stroke (RR 1.35; 95% CI 0.86-2.11; P = 0.19). Using the totality of evidence available through 2015, this meta-analysis failed to show that the routine use of aspiration thrombectomy in patients with ST-elevation myocardial infarction significantly reduces all-cause mortality, MACE, recurrent MI, TVR, or stent thrombosis. The role of aspiration thrombectomy in selected patients with angiographic evidence of large thrombus burden requires further clinical investigation. © 2015 Wiley Periodicals, Inc.

Aspiration Thrombectomy for Treatment of ST-segment Elevation Myocardial Infarction: a Meta-analysis of 26 Randomized Trials in 11 943 Patients

Introduction and objectivesThere is continued debate about the routine use of aspiration thrombectomy in patients with ST-segment elevation myocardial infarction. Our aim was to evaluate clinical and procedural outcomes of aspiration thrombectomy-assisted primary percutaneous coronary intervention compared with conventional primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. MethodsWe performed a meta-analysis of 26 randomized controlled trials with a total of 11 943 patients. Clinical outcomes were extracted up to maximum follow-up and random effect models were used to assess differences in outcomes. ResultsWe observed no difference in the risk of all-cause death (pooled risk ratio = 0.88; 95% confidence interval, 0.74-1.04; P = .124), reinfarction (pooled risk ratio = 0.85; 95% confidence interval, 0.67-1.08; P = .176), target vessel revascularization (pooled risk ratio = 0.86; 95% confidence interval, 0.73-1.00; P = .052), or definite stent thrombosis (pooled risk ratio = 0.76; 95% confidence interval, 0.49-1.16; P = .202) between the 2 groups at a mean weighted follow-up time of 10.4 months. There were significant reductions in failure to reach Thrombolysis In Myocardial Infarction 3 flow (pooled risk ratio = 0.70; 95% confidence interval, 0.60-0.81; P < .001) or myocardial blush grade 3 (pooled risk ratio = 0.76; 95% confidence interval, 0.65-0.89; P = .001), incomplete ST-segment resolution (pooled risk ratio = 0.72; 95% confidence interval, 0.62-0.84; P < .001), and evidence of distal embolization (pooled risk ratio = 0.61; 95% confidence interval, 0.46-0.81; P = .001) with aspiration thrombectomy but estimates were heterogeneous between trials. ConclusionsAmong unselected patients with ST-segment elevation myocardial infarction, aspiration thrombectomy-assisted primary percutaneous coronary intervention does not improve clinical outcomes, despite improved epicardial and myocardial parameters of reperfusion.Full English text available from:www.revespcardiol.org/en

Trombectomía por aspiración para el tratamiento del infarto agudo de miocardio con elevación del segmento ST: un metanálisis de 26 ensayos aleatorizados con 11.943 pacientes

Introduction and objectivesThere is continued debate about the routine use of aspiration thrombectomy in patients with ST-segment elevation myocardial infarction. Our aim was to evaluate clinical and procedural outcomes of aspiration thrombectomy-assisted primary percutaneous coronary intervention compared with conventional primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. MethodsWe performed a meta-analysis of 26 randomized controlled trials with a total of 11 943 patients. Clinical outcomes were extracted up to maximum follow-up and random effect models were used to assess differences in outcomes. ResultsWe observed no difference in the risk of all-cause death (pooled risk ratio = 0.88; 95% confidence interval, 0.74-1.04; P = .124), reinfarction (pooled risk ratio = 0.85; 95% confidence interval, 0.67-1.08; P = .176), target vessel revascularization (pooled risk ratio = 0.86; 95% confidence interval, 0.73-1.00; P = .052), or definite stent thrombosis (pooled risk ratio = 0.76; 95% confidence interval, 0.49-1.16; P = .202) between the 2 groups at a mean weighted follow-up time of 10.4 months. There were significant reductions in failure to reach Thrombolysis In Myocardial Infarction 3 flow (pooled risk ratio = 0.70; 95% confidence interval, 0.60-0.81; P < .001) or myocardial blush grade 3 (pooled risk ratio = 0.76; 95% confidence interval, 0.65-0.89; P = .001), incomplete ST-segment resolution (pooled risk ratio = 0.72; 95% confidence interval, 0.62-0.84; P < .001), and evidence of distal embolization (pooled risk ratio = 0.61; 95% confidence interval, 0.46-0.81; P = .001) with aspiration thrombectomy but estimates were heterogeneous between trials. ConclusionsAmong unselected patients with ST-segment elevation myocardial infarction, aspiration thrombectomy-assisted primary percutaneous coronary intervention does not improve clinical outcomes, despite improved epicardial and myocardial parameters of reperfusion.Full English text available from:www.revespcardiol.org/en

Angiographic characteristics of definite stent thrombosis: role of thrombus grade, collaterals, epicardial coronary flow, and myocardial perfusion.

To characterize the prevalence of thrombus burden, collateral vessels to the infarct-related artery, epicardial coronary artery flow, and myocardial perfusion in patients with angiographically confirmed definite stent thrombosis (ST), and to define their relationship with associated treatments and outcomes. Angiographic characteristics of ST are not well defined. All cases of angiographically determined ST at five academic hospitals from 2005 to 2012 were reviewed. Demographic, procedural, and angiographic characteristics were recorded. In-hospital and 1-year follow-up data were obtained. Among 205 cases of angiographic definite ST (60 ± 8 years; 87% male), the majority presented with late/very late ST (69%) and STEMI (66%). High-risk angiographic findings at presentation included thrombus grade 4-5 (87%), absence of collateral vessels (76%), and reduced initial TIMI 3 flow (90%). Final TIMI 3 flow was achieved in 90% of patients and was associated with greater use of aspiration thrombectomy (60% vs. 25%; P = 0.003), glycoprotein IIb/IIIa inhibitors (80% vs. 30%, P < 0.001), and repeat stenting (67% vs. 10%, P < 0.001). A final myocardial perfusion grade of 2-3 was achieved in 79% of patients and was associated with greater use of aspiration thrombectomy (61% vs. 36%, P = 0.003). After multivariable logistic regression, aspiration thrombectomy (AOR 2.6, 95% CI 1.3-5.2) and implantation of a new stent (AOR 2.1, 95% CI 1.1-4.3) were associated with optimal combined epicardial flow and myocardial perfusion. At 1-year follow-up, significantly lower risk of repeat ST (HR 0.1; 95% CI 0.1,0.2; P < 0.001) among patients with initial TIMI 3 flow at index ST was observed. The majority of ST patients present with late/very late ST with high thrombus burden and STEMI. Presence of collateral vessels and low thrombus burden is cardioprotective, while reduced initial TIMI flow is associated with larger infarct size and recurrent ST. Aspiration thrombectomy and repeat stenting are associated with improved epicardial coronary artery flow and myocardial perfusion among patients treated for ST. © 2014 Wiley Periodicals, Inc.

Procedural success and long‐term outcomes of aspiration thrombectomy for the treatment of stent thrombosis

Stent thrombosis (ST) is associated with a significant burden of coronary thrombus and potential microvascular obstruction. Aspiration thrombectomy may decrease the extent of microvascular obstruction in patients with acute myocardial infarction but its role in the treatment of ST is uncertain. The present study sought to evaluate the association between aspiration thrombectomy, procedural success and long-term outcomes among patients presenting with ST. In a multicenter cohort of patients with definite ST, procedural success, long-term mortality, and major adverse cardiovascular events (death, stroke, re-infarction, revascularization) were ascertained. Propensity weighting was used to determine the association between aspiration thrombectomy and long-term outcomes. A total of 205 patients with ST were identified. Among these, 115 (56%) patients underwent adjunctive aspiration thrombectomy during percutaneous coronary intervention. Patients undergoing aspiration thrombectomy were more likely to present with ST-elevation myocardial infarction (75% vs. 52%, P < 0.003) and require hemodynamic support (19% vs. 10%, P = 0.07). Aspiration thrombectomy was associated with improved procedural outcomes including postprocedural TIMI 3 flow, resulting in higher angiographic and procedural success (each 96% vs. 83%, P < 0.001). Despite improved angiographic outcomes, the use of aspiration thrombectomy was not associated with a difference in long-term mortality (adjusted HR 0.99, 95% CI 0.44-2.24) or major adverse cardiovascular events (adjusted HR 1.06, 95% CI 0.45-2.48). Aspiration thrombectomy is associated with improved coronary flow and procedural success but is not associated with improved long-term outcomes among patients undergoing percutaneous intervention for definite ST. NCT00931502 (http://www.clinicaltrials.gov/ct2/show/NCT00931502)

An international survey of clinical practice during primary percutaneous coronary intervention for ST-elevation myocardial infarction with a focus on aspiration thrombectomy

Data suggest that there is a variable use of thrombectomy during primary percutaneous coronary interventions (PPCI). We sought to evaluate practices during PPCI for ST-elevation myocardial infarction (STEMI), including the use of aspiration thrombectomy, and to determine the feasibility of conducting a definitive aspiration thrombectomy trial. A 27-item online survey was distributed to 1,607 interventional cardiologists internationally. A total of 461 responses were received. During PPCI, aspiration thrombectomy is used routinely by 36% of respondents, and selectively by 60%. Twenty-five percent of respondents reported experiencing a complication related to thrombectomy including: vessel dissection (13%), bringing thrombus back into left main coronary artery from target vessel (5%), stroke or transient ischaemic attack (2%), and coronary artery perforation (1%). The vast majority of respondents (89%) believe that a confirmatory aspiration thrombectomy trial is needed and 85% would be willing to randomise patients in such a trial. The majority of interventional cardiologists surveyed are not using thrombectomy routinely during PPCI. The survey results suggest that a large, confirmatory thrombectomy trial is needed and feasible in the current era. The survey also highlights a significant level of variability and underutilisation of other evidence-based therapies during PPCI.

Use of aspiration thrombectomy in a 102-year-old patient with acute inferior ST-segment elevation myocardial infarction

It has been demonstrated that primary percutaneous coronary intervention (PPCI) is the best treatment option for ST-segment elevation myocardial infarction (STEMI) [ [1] Keeley E.C. Boura J.A. Grines C.L. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomized trials. Lancet. 2003; 361: 13-20 Abstract Full Text Full Text PDF PubMed Scopus (3518) Google Scholar ]. PPCI is an effective method of epicardial flow restoration. Normal epicardial flow in the infarct-related artery is not equal to the restoration of myocardial perfusion at the microcirculation level. It seems that the main reason for impaired myocardial reperfusion is embolization by thrombus and plaque debris. Recent trials have demonstrated that thrombectomy can improve angiographic results of PPCI [ 2 De Luca G. Suryapranata H. Stone G.W. et al. Adjunctive mechanical devices to prevent distal embolization in patients undergoing mechanical revascularization for acute myocardial infarction: a meta-analysis of randomized trials. Am Heart J. 2007; 153: 343-353 Abstract Full Text Full Text PDF PubMed Scopus (142) Google Scholar , 3 Dudek D. Mielecki W. Burzotta F. et al. Thrombus aspiration followed by direct stenting: a novel strategy of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction. Results of the Polish–Italian–Hungarian RAndomized ThrombEctomy Trial (PIHRATE Trial). Am Heart J. 2010; 160: 966-972 Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar ].

TCT-313: A randomized Controlled Trial of Upstream versus Bail-out Use of Glycoprotein IIb/IIIa Inhibitor Combined with Selective Use of Aspiration Thrombectomy during Primary Percutaneous Coronary Intervention in Patients with ST-segment Elevation Myocardial Infarction

TCT-313: A randomized Controlled Trial of Upstream versus Bail-out Use of Glycoprotein IIb/IIIa Inhibitor Combined with Selective Use of Aspiration Thrombectomy during Primary Percutaneous Coronary Intervention in Patients with ST-segment Elevation Myocardial Infarction

Abstract 6181: ST Segment Resolution and Pathological Findings of Aspirated Materials in Patients with ST Elevation Acute Myocardial Infarction

Early resolution of ST-segment elevation (STR) is a potent predictor of better clinical outcome after PCI in ST elevation acute myocardial infarction (STEMI). The aim of this study was to determine the association of aspirated materials and serial change of ST elevation. We studied 150 consecutive STEMI patients with assessable ECG recording, in whom standard PCI was performed with the adjunctive use of aspiration thrombectomy. STR(+) was defined as more than 50% resolution of ST-segment elevation at 60min after PCI. Aspirated materials were pathologically classified into thrombus only group (fresh, lytic, or organized) or thrombus and atheroma complex group, and compared between STR(+) and STR(−). TIMI flow grade, IVUS findings after aspiration(ruptured plaque, calcification, thrombus and echo signal attenuation), area under the curve (AUC) of CK-MB release, and pathological findings were also compared between the two groups. Seventy-six patients (50.6%) showed STR and 74 patients didn’t. RCA culprit lesion was significantly more frequent in STR(+)(P&lt;0.05). There was no significant difference in other patient characteristics or IVUS findings in the present cohort. AUC of CK-MB was lower in STR(+)(p=0.02). TIMI 3 flow was more frequently achieved in STR(+)(p&lt;0.05). Fresh thrombus was more frequent in STR(+)(p&lt;0.05), whereas atheromatous component and lytic or organized thrombus were frequently observed in STR(−)(p&lt;0.05). Culprit lesions in STEMI, when atheroma and thrombus complex with lytic or organized thrombus was aspirated, caused more myocardial damage and less frequent STR.