In four selected patients presenting with ST-segment elevation myocardial infarction (STEMI), aspiration thrombectomy allowed for full filling defect angiographic ‘cleaning’ of the culprit arteries without need for stent implantation. Obtaining good angiographic results and uneventful early and long-term clinical outcome after thrombus aspiration alone raises the question as to whether stenting the infracted thrombotic artery is mandatory and routinely indicated in every single STEMI patient treated with primary percutaneous coronary intervention.
KeeleyECHillisD. Primary PCI for myocardial infarction with ST-segment elevation. N Engl J Med2007; 356: 47–54.
2.
SvilaasTVlaarPJHorstIC. Thrombus aspiration during primary percutaneous coronary intervention. N Engl J Med2008; 358: 557–567.
3.
StoneGWMaeharaAWitzenbichlerB. Intracoronary Abciximab and aspiration thrombectomy in patients with large anterior myocardial infarction. The INFUSE-AMI Randomized Trial. JAMA2012; 307: 1817–1826.
4.
StoneGW. Simple aspiration in acute myocardial infarction: too simple to be true?Eur Heart J2012; 33: 3005–3007.
5.
Task Force on the Management of ST-segment Elevation Acute Myocardial Infarction of the European Society of Cardiology (ESC), StegPGJamesSK. ESC guidelines for the management of acute myocardial infarction presenting with ST-segment elevation. Eur Heart J2012; 33: 2569–2619.
6.
2013 ACCF/AHA guidelines for the management of ST-elevation myocardial infarction. J Am Coll Cardiol2013; 61: e78–e140.
7.
BroshDAssaliARMagerA. Effect of no reflow during primary percutaneous coronary intervention for acute myocardial infarction on six-month mortality. Am J Cardiol2007; 99: 442–445.
8.
FrobertOLagerqvistBOlivecronaGK. Thrombus aspiration during ST-segment elevation myocardial infarction. N Engl J Med2013; 369: 1587–1597.
9.
StoneGWLanskyAJPocockSJ. For the Horizon-AMI trial investigators. Paclitaxel-eluting stents versus bare metal stents in acute myocardial infarction. N Engl J Med2009; 360: 1946–1959.
10.
SianosGPapafaklisMDaemenJ. Angiographic stent thrombosis after routine use of drug eluting stents in STEMI: the importance of thrombotic burden. J Am Coll Cardiol2007; 50: 573–583.
11.
ViolarisAGMelkertRHerrmanJP. Role of angiographically identifiable thrombus on long-term luminal renarrowing after coronary angioplasty: a quantitative angiographic analysis. Circulation1996; 93: 889–897.
12.
IakovouISchmidtTBonizzoniE. Incidence, predictors, and outcome of thrombosis after successful implantation of drug eluted stents. JAMA2005; 293: 2126–2130.
13.
BrodieBPokharelYFleishmanN. Very late stent thrombosis after primary percutaneous coronary interventions with bare-metal and drug-eluting stents for ST-segment elevation myocardial infarction. J Am Coll Cardiol2011; 4: 30–38.
14.
NakazawaGFinnAVJonerM. Delayed arterial healing and increased late stent thrombosis at culprit sites after drug-eluting stent placement for acute myocardial infarction patients: an autopsy study. Circulation2008; 118: 1138–1145.
15.
PratiFUemuraSSouteyrandG. OCT-based diagnosis and management of STEMI associated with intact fibrous cap. J Am Coll Cardiol Img2013; 6: 283–7.
16.
ThieleHSchindlerKFriedenbergerJ. Intracoronary compared with intravenous bolus abciximab application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Circulation2008; 118: 49–57.
