Baylor University Medical Center Proceedings July 2017 - 273

Effect of thrombus aspiration on angiography and outcome
in patients undergoing primary coronary angioplasty
Praveen Chacko, MD, DM, Kesavapillai Jayaprakash, MD, DM, Kamarudheenkunju Jameelabeevi Raihanathul Misiriya,
MD, DM, Suresh Madhavan, MD, DM, Vasantha Sudha Kumary, MD, DM, Narayanapillai Jayaprasad, MD, DM,
Vaikathusseril Lembodaran Jayaprakash, MD, DM, and Raju George, MD, DM

Thrombus exerts a major impact on the performance and outcome of
primary and rescue interventions in acute ST-elevation myocardial infarction. Although the optimal treatment of thrombotic lesions is still controversial, thrombus aspiration provides an effective method to achieve
successful reperfusion during primary angioplasty. We compared clinical
and angiographic outcomes in 286 patients with acute ST-elevation
myocardial infarction undergoing primary percutaneous transluminal
coronary angioplasty (PTCA) and thrombus aspiration with those who
underwent conventional PTCA without thrombus aspiration. Thrombus
aspiration during primary percutaneous coronary intervention in patients
with high thrombus burden resulted in better Thrombolysis in Myocardial
Infarction (TIMI) 3 flow in the infarct-related artery and helped achieve
faster ST-segment resolution on the electrocardiogram compared with
conventional angioplasty without thrombus aspiration.

hrombus is a hallmark constituent of active, unstable atherosclerotic plaques commonly found in patients with acute
coronary syndromes. Over the past three decades, percutaneous coronary intervention (PCI) has achieved high success
rates with the ever-increasing inclusion of complex target lesions
(1). However, despite this impressive progress, one critical component, thrombus, remains a formidable obstacle to revascularization.
Thrombus exerts a major impact on the outcome of primary and
rescue interventions. The optimal treatment of thrombotic lesions is
still enigmatic and controversial. Still thrombus aspiration provides
an eﬀective method to achieve successful reperfusion in primary
angioplasty. The present study aimed to compare clinical and angiographic outcomes in patients with acute ST-elevation myocardial
infarction undergoing primary percutaneous transluminal coronary
angioplasty (PTCA) with and without thrombus aspiration.
METHODS
The study included 344 patients with a history and
electrocardiographic changes suggestive of acute ST-elevation
myocardial infarction, who presented within 12 hours of symptom onset and were admitted to the cardiology department. Patients with previous myocardial infarction and those undergoing
rescue PCI after thrombolysis were excluded from the study. Coronary angiography with the standard angiographic projections
was done in these patients. The images were critically analyzed
Proc (Bayl Univ Med Cent) 2017;30(3):273-275

for the presence and severity of any obstructive coronary arteries
in all the coronary arterial territories. Other angiographic features
were noted, including the vessel diameter, lesion morphology,
tortuosity, ectasia, dissection, calciﬁcation, and thrombus. The
infarct-related artery was identiﬁed and evaluated for the above
angiographic characteristics, including the vessel and lesion morphology, with special focus on the presence or absence of intracoronary thrombus, the Thrombolysis in Myocardial Infarction
(TIMI) thrombus score, and the antegrade ﬂow (TIMI grade).
In patients showing thrombus in the initial angiogram, further management was planned according to the patient's clinical
status and the operator's discretion, which was based on the
TIMI thrombus grade and other angiographic characteristics
of the infarct-related vessel and the morphology of the culprit
lesion. Patients with low thrombus burden (TIMI thrombus
grades 1 and 2, n = 36) were excluded from further analysis.
For all patients, the ﬁrst procedural step was the passing of
a ﬂoppy, steerable guidewire through the target lesion. In patients in the thrombus aspiration group, this step was followed
by the advancing of a 6Fr Thrombuster II Aspiration Catheter
(crossing proﬁle, 0.07 in/1.78 mm) into the target coronary
segment during continuous aspiration. When necessary for
stent delivery, balloon dilation was performed before stenting
(Figure 1). Patients in the conventional PCI group were treated
without thrombus aspiration, and balloon dilation to establish
antegrade ﬂow was done after crossing the culprit lesion with
the guidewire. In all patients, after the restoration of antegrade
ﬂow, intracoronary nitroglycerine was given to ensure maximal
epicardial vasodilation, in order to determine the size and length
of the stent and to facilitate stent placement. Drug-eluting stents
(sirolimus or everolimus) were used for all patients.
Those who underwent balloon angioplasty alone without implantation of a stent because of various reasons such as
small vessels, calciﬁed lesions, or nondilatable lesions (n = 22)
were excluded from the study. Of the remaining 286 patients,
155 patients receiving primary PTCA with thrombus aspiration
and stent implantation were in the treatment group and
From the Department of Cardiology, Government Medical College, Kottayam,
Kerala, India.
Corresponding author: K. Jayaprakash, MD, DM, Government Medical College,
Kottayam, Kerala, India PIN 686008 (e-mail: jayaprakashkpillai@gmail.com).
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