Thrombus aspiration in acute myocardial infarction

Rupture of an atherosclerotic plaque is the principal mechanism responsible for the development of an acute coronary syndrome. Thrombus formation ensues rapidly on the surface of the injured endothelium. When the infarct vessel is completely occluded, ST-elevation myocardial infarction is diagnosed and urgent reperfusion is required. While infarct artery patency can be restored in most patients, adequate reperfusion at the tissue level is achieved much less often because of distal embolization of plaque and thrombus. Manual thrombus aspiration has been shown to reduce thrombus burden and improve markers of reperfusion, such as epicardial flow (thrombolysis in myocardial infarction flow), myocardial blush grade and ST-elevation resolution, compared with conventional balloon angioplasty and stenting. In one study, mortality was also reduced, but this result could not be duplicated in other series. Additional research is needed to clarify the exact role of manual thrombectomy in the management of ST-elevatio...