title: Thrombus aspiration alone during primary percutanous coronary intervention as definitive treatment in acute ST-elevation myocardial infarction.
abstract: BACKGROUND
  In some patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutanous coronary intervention (pPCI) with thrombus aspiration, residual stenosis after thrombus aspiration is non-significant and additional balloon dilatation or stent placement may be unnecessary. We investigated the angiographic, procedural, and clinical outcomes of these patients in our single center pPCI-database. In addition, to gain insight in the pathological mechanisms of coronary thrombosis in these patients, we established the histopathological characteristics and age of the aspirated material.
  
  
  METHODS
  This study consists of STEMI patients who underwent pPCI with thrombus aspiration alone in our institution. Thrombus material was collected and processed and the sections were analyzed for the presence of fresh (<1 day) or older thrombus (>1 day) and plaque components. One year clinical follow-up was obtained and vital status was assessed up to March 2010.
  
  
  RESULTS
  We identified 16 STEMI patients who underwent thrombus aspiration alone as the definitive treatment during pPCI. Acceptable flow with minimal non-significant residual stenosis immediately after thrombus aspiration was present in 14 patients (88%). In four patients (25%) repeat angiography was performed after several days and disappearance of the residual thrombus could be confirmed in three patients. During follow-up, repeat target lesion revascularization was performed in one patient at 53 days. No recurrent myocardial infarction was observed. Two patients died 1,166 and 1,228 days after the index-event from non-cardiac causes.
  
  
  CONCLUSIONS
  In selected STEMI patients undergoing pPCI, thrombus aspiration alone is feasible and safe on the short-term and there appears to be no high risk of recurrent ischemic events during follow-up. Our results suggest that additional balloon inflation or stent implantation may be unnecessary in selected patients, when there is no significant residual stenosis after thrombus aspiration.
authors: Department of Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors: Miranda C
authors: MC
authors: Kramer
authors: Niels C
authors: NC
authors: Verouden
authors: Xiaofei
authors: X
authors: Li
authors: Karel T
authors: KT
authors: Koch
authors: Allard C
authors: AC
authors: van der Wal
authors: Jan G
authors: JG
authors: Tijssen
authors: Robbert J
authors: RJ
authors: de Winter
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D003328:Coronary Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D016208:Databases, Factual; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D009426:Netherlands; D012008:Recurrence; D013396:Suction; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome