Sustained mechanical aspiration thrombectomy for acute coronary syndrome with large thrombus burden: The Aspiration, Vasodilators, Imaging, and Stenting (AVIS) protocol.

STUDY

OBJECTIVE

To evaluate the effectiveness and safety of sustained mechanical aspiration thrombectomy in acute coronary syndrome (ACS) patients with a large thrombus burden (LTB).

DESIGN

This is a prospective observational study.

SETTING

A Tertiary Healthcare Center in North India.

PARTICIPANTS

ACS patients with LTB recommended for percutaneous coronary intervention (PCI).

INTERVENTION: Upfront sustained mechanical aspiration thrombectomy with The Indigo™ system CAT™ RX (Penumbra Inc., Alameda, CA) before primary PCI.

MAIN OUTCOME: Primary outcomes included improvement in thrombolysis in myocardial infarction (TIMI) flow, TIMI thrombus grade, and myocardial blush grade (MBG). Clinical outcomes (death, recurrent MI, stroke) and improvement in LV function were recorded at baseline, 1 month and 6 months.

RESULTS

Among 105 patients (median age 55 years, 82.9 % male), most had grade 5 thrombus (84.8 %), MBG grade 0 (84.8 %), and TIMI grade 0 flow (82.9 %) at baseline. After the procedure, significant improvements were observed in TIMI flow, TIMI thrombus grade, and MBG (p < 0.001). Three deaths were reported within the first 30 days, none of which were device related. There was a significant increase in the mean left ventricular ejection fraction from baseline to six month follow up (38.37 % vs. 44.63; p < 0.001).

CONCLUSION

Sustained mechanical aspiration thrombectomy effectively removed clots and aided in optimal myocardial perfusion in ACS patients with LTB. This study also proposes the utilization of the Aspiration, Vasodilators, Imaging, Stenting (AVIS) protocol to improve procedural success.