Urgent PCI in patients with stent thrombosis: an observational single-center study comparing thrombus aspiration and standard PCI.
OBJECTIVE
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 out of 18) vs. 33% (5 out of 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.
De Vita
Maria
M
Institute of Cardiology, Catholic University, Via B. Barbiellini Amidei, 80, 00168, Rome, Italy. mariarosariadevita77@libero.it
Burzotta
Francesco
F
Trani
Carlo
C
Romagnoli
Enrico
E
Talarico
Giovanni Paolo
GP
Porto
Italo
I
Leone
Antonio Maria
AM
Biondi-Zoccai
Giuseppe G L
GG
Niccoli
Giampaolo
G
Rebuzzi
Antonio Giuseppe
AG
Mongiardo
Rocco
R
Mazzari
Mario Attilio
MA
Schiavoni
Giovanni
G
Crea
Filippo
F
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation / Q000379:methods*; D000925:Anticoagulants / Q000627:therapeutic use; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D017131:Thrombectomy; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants; D006493:Heparin