Thrombus aspiration for the treatment of definite stent thrombosis.

BACKGROUND

Thrombus aspiration (TA) has been associated with high rates of thrombotic material retrieval, which results in improved myocardial reperfusion. In addition, a recent study has shown that systematic TA for treatment of ST-segment elevation myocardial infarction (STEMI) related to de novo lesions improves patient outcomes.

AIMS: Evaluation of a single-centre experience of TA before percutaneous coronary intervention (PCI) for stent thrombosis (ST) treatment.

METHODS

Between 2004 and 2006, we indexed 24 patients presenting with definite ST. All patients underwent TA (Export Medtronic 6F catheter) followed by PCI for ST treatment. Baseline clinical and angiographic characteristics, and complications related to the TA device were indexed.

RESULTS

The median time of ST occurrence was 7 days. All patients except one presented with STEMI. Bare-metal and drug-eluting ST represented 70.8% and 29.2% of cases, respectively. Mean stent length was 18.8 + or - 5.6mm; mean stent diameter was 2.8 + or - 0.4mm; mean number of implanted stents was 1.58 + or - 0.7. There was no failure to cross the catheter and no TA device-related complications were reported. The numbers of patients with initial thrombolysis in myocardial infarction (TIMI) flow grades 0, 1 and 2 were 15 (62.5%), 3 (12.5%) and 6 (25.0%), respectively. No patient had TIMI flow grade 3 before TA. After TA, 16 (66.7%) patients had TIMI flow grade 3; final procedural success was obtained in 23 (95.8%) patients. The 1-year death rate was 12.5%.

CONCLUSIONS

In our experience, TA before PCI for ST treatment shows promising results, providing high rates of immediate reperfusion and final angiographic success, and low death rates, compared with the literature.