Background: Current practice of routine use of
Aspiration Thrombectomy (AT) during Primary PCI has been challenged after publications of INFUSE AMI trial and TASTE prospective meta analysis results. Complications related to AT use have not been sufficiency investigated.
Methods: Angiographic results were evaluated in 182 patients with STEMI that underwent AT during primary PCI between Jan 2008 – Jan 2013. AT was the initial interventional step in included patients. Pronto LP 6F, Export AP 6F, Eliminate 6 & 7F, Quick Cat 6F, Recover 6 & 7F aspiration catheters were used.
Results: Sixty eight (63%) of all patients with STEMI treated by primary PCI were planned to start with AT. In 14 (7.5%) cases AT was aborted due to failure to pass device through culprit artery. 104 pts underwent AT followed by direct stenting, 61 pts underwent AT followed by additional balloon predilatation before stenting, and 3 pts underwent AT with balloon only. Culprit lesions were localized in LAD (n=63), CX/M/RM (n=44) and RCA (n=61). TIMI flow was II-III in 57 (34%) patients, 111 (66%) had TIMI 0-I.
Immediately after AT, in 96 (57%) of the pts TIMI flow score was improved; in 63 (37.5%) there was no change; in 9 (5.4%) cases it deteriorated.
AT was complicated by serious dissection in 8 (4.8%) patients, however this was completely resolved after stent implantation. In 26 (15.5%) pts the complication was visible distal embolization; in 19 (11.3%) side branch compromise or obstruction; in 6 pts (3.6%) retrograde embolisation to proximal side branch or another artery; in 4 (2.4%) pts retrograde plaque shifting.
Final angiographic success in this group was 92%.
Conclusions: Use of AP in Primary PCI is associated with relatively rare but significant procedural complications such as deterioration of coronary flow, dissection, distal embolization, side branch occlusion, retrograde embolization and thrombus shifting.
