title: Reduction of atherothrombotic burden before stent deployment in non-ST elevation acute coronary syndromes: Reduction of myocardial necrosis achieved with nose-dive manual thrombus aspiration (REMNANT) trial. A volumetric intravascular ultrasound study.
abstract: OBJECTIVE
  To test whether thrombus aspiration (TA) reduces the atherosclerotic burden in culprit lesions and "facilitate" percutaneous coronary intervention with stent (S-PCI) among patients with non-ST elevation acute coronary syndromes (NSTE-ACS).
  
  
  BACKGROUND
  Evidence on the effects of TA adjunctive to S-PCI in NSTE-ACS is limited and controversial.
  
  
  METHODS
  TA was defined "aggressive" when using 7F devices or a catheter/artery ratio >0.6, "conservative" with 6F, and a catheter/artery ratio ≤0.6. Angiography and intravascular ultrasound (IVUS) were performed at baseline, after TA and after stent deployment.
  
  
  RESULTS
  TA was accomplished in 61/76 patients (80%) with NSTE-ACS. The aspirated material was red thrombus in 23% and plaque fragments in 49% of cases. Compared with baseline, TA was associated with an 82% increase in minimal lumen diameter and a 15% reduction in diameter stenosis (P < 0.001 for both). After TA, IVUS documented a 24 and 16% increase in minimal lumen area and lumen volume, respectively (P < 0.001 for both), a 7% decrease in area stenosis through an 11% reduction of plaque + media volume (P < 0.001). When compared with "conservative", an "aggressive" TA was associated with a more pronounced reduction in percent area stenosis (P < 0.05) and an increase in percent stent expansion (P < 0.001). The plaque + media volume reduction after TA was correlated with stent expansion (r = 0.261, P = 0.046).
  
  
  CONCLUSIONS
  Manual TA reduces atherothrombotic burden in culprit lesions of NSTE-ACS patients before S-PCI and, when deep plaque removal is obtained, TA optimizes subsequent stent expansion. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zimarino
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Angeramo
authors.affiliation: Interventional Cardiology at St George's, University of London, London, United Kingdom.
authors.forename: Abhiram
authors.initials: A
authors.lastname: Prasad
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Ruggieri
authors.affiliation: Institute of Pathology and Cardiovascular and Oncological Molecular Medicine, Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Malatesta
authors.affiliation: Catheterization Laboratory, San Giovanni Hospital, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Prati
authors.affiliation: Institute of Pathology and Cardiovascular and Oncological Molecular Medicine, Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
authors.forename: Fiamma
authors.initials: F
authors.lastname: Buttitta
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: De Caterina
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D000368:Aged; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000517:prevention & control*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011446:Prospective Studies; D015607:Stents; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: IVUS; non-ST elevation acute coronary syndromes; thrombus aspiration