Urgent PCI in Patients With Stent Thrombosis: Thrombus Aspiration vs PCI
Urgent PCI in Patients With Stent Thrombosis: Thrombus Aspiration vs PCI
Objectives. Stent thrombosis (ST) is a recognized complication of percutaneous coronary interventions (PCI). Due to the high thrombus burden present in ST, the use of thrombus aspiration (TA) may enhance the angiographic results by limiting distal embolization. Methods. Consecutive patients undergoing urgent PCI due to ST were studied, consisting of two groups according to the type of intervention (standard PCI [SP] or TA). TIMI flow, corrected TIMI frame count (cTFC), myocardial blush grade (MBG), thrombus score (TS), Yip's adverse thrombus burden features, occurrence of angiographically evident distal embolization (DE) were evaluated offline. In-hospital outcomes were also recorded. Results. Twenty-eight patients entered the study. Baseline clinical and angiographic features were similar between patients treated by SP (n = 12) and those treated by TA (n = 16). After PCI, a trend in favor of TA as compared to SP was observed for post-PCI TIMI 3 flow rate (67% vs. 89%; p = 0.10), final cTFC (31 ± 35 vs. 17 ± 21; p = 0.10) and MBG 2–3 rate (40% vs. 67%; p = 0.12). Accordingly, the rate of adverse angiographic outcome (post-PCI TIMI 0–1 flow and/or DE) was significantly lower in the TA as compared to SP: 5% (1/18) vs 33% (5/15) respectively (p = 0.04). Throughout hospitalization, major adverse events occurred in 6% of TA patients vs. 33% of SP patients (p = 0.08). Conclusions. TA in patients with ST is safe and is associated with better angiographic outcomes compared to standard PCI. Larger studies are warranted to confirm these early observations.
Stent thrombosis (ST) is a recognized complication limiting the clinical efficacy of percutaneous coronary interventions (PCI), the incidence reported being between 0.5% and 2.2%. Due to the increasing number of stent-based PCI procedures, the absolute number of patients experiencing ST is expected to expand, and the introduction of drug-eluting stents in clinical practice is expected to change the histopathology, presentation and possibly the incidence of patients with ST.
Despite the evident clinical relevance associated with ST, its management is not well established. Re-PCI represents the most frequently adopted strategy for ST, but yields unsatisfactory results, as it is associated with a high risk of death and recurrent ST. Recently-developed devices able to remove the thrombus and reduce distal embolization might improve the outcome of patients undergoing PCI for ST.
We report a comparison of the angiographic results obtained with standard PCI (SP) or with PCI associated with thrombus aspiration (TA) using a device that was recently tested successfully in patients undergoing primary PCI.
Objectives. Stent thrombosis (ST) is a recognized complication of percutaneous coronary interventions (PCI). Due to the high thrombus burden present in ST, the use of thrombus aspiration (TA) may enhance the angiographic results by limiting distal embolization. Methods. Consecutive patients undergoing urgent PCI due to ST were studied, consisting of two groups according to the type of intervention (standard PCI [SP] or TA). TIMI flow, corrected TIMI frame count (cTFC), myocardial blush grade (MBG), thrombus score (TS), Yip's adverse thrombus burden features, occurrence of angiographically evident distal embolization (DE) were evaluated offline. In-hospital outcomes were also recorded. Results. Twenty-eight patients entered the study. Baseline clinical and angiographic features were similar between patients treated by SP (n = 12) and those treated by TA (n = 16). After PCI, a trend in favor of TA as compared to SP was observed for post-PCI TIMI 3 flow rate (67% vs. 89%; p = 0.10), final cTFC (31 ± 35 vs. 17 ± 21; p = 0.10) and MBG 2–3 rate (40% vs. 67%; p = 0.12). Accordingly, the rate of adverse angiographic outcome (post-PCI TIMI 0–1 flow and/or DE) was significantly lower in the TA as compared to SP: 5% (1/18) vs 33% (5/15) respectively (p = 0.04). Throughout hospitalization, major adverse events occurred in 6% of TA patients vs. 33% of SP patients (p = 0.08). Conclusions. TA in patients with ST is safe and is associated with better angiographic outcomes compared to standard PCI. Larger studies are warranted to confirm these early observations.
Stent thrombosis (ST) is a recognized complication limiting the clinical efficacy of percutaneous coronary interventions (PCI), the incidence reported being between 0.5% and 2.2%. Due to the increasing number of stent-based PCI procedures, the absolute number of patients experiencing ST is expected to expand, and the introduction of drug-eluting stents in clinical practice is expected to change the histopathology, presentation and possibly the incidence of patients with ST.
Despite the evident clinical relevance associated with ST, its management is not well established. Re-PCI represents the most frequently adopted strategy for ST, but yields unsatisfactory results, as it is associated with a high risk of death and recurrent ST. Recently-developed devices able to remove the thrombus and reduce distal embolization might improve the outcome of patients undergoing PCI for ST.
We report a comparison of the angiographic results obtained with standard PCI (SP) or with PCI associated with thrombus aspiration (TA) using a device that was recently tested successfully in patients undergoing primary PCI.
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