Impact of manual thrombus extraction on improving myocardial tissue level perfusion and left ventricular remodeling in ST segment elevation myocardial infarction: a prospective comparative study

ABSTRACT

Background: Despite restoration of epicardial blood flow with primary PCI, microvascular obstruction with diminished myocardial perfusion occurs in large proportion of patients. Thrombus manual-aspiration seems to be practical for resolving these issues.

Objective: Evaluate the effect of the Diver TMC.E., aspiration thrombectomy catheter as an adjunct to primary PCI on myocardial perfusion and left ventricular functional recovery and remodeling.

Methods: We included 40 patients [57.8±9.3 year, 31 (77.5 %) males] with acute STEMI eligible for primary PCI. Patients were assigned to undergo either standard PCI (standard PCI group=control group) or PCI with thrombus aspiration (DiverCE thrombus-aspiration group=study group).Results: Both groups were comparable with no significant differences regarding demographic, clinical, echocardiographic, and angiographic parameters. The percent of thrombus burden reduction was significantly higher in study group (73.50 ± 19.13 %) compared to control group (50.75 ± 23.75 %) (P = 0.002). TIMI flow grade 3 was achieved in 100 % of the DiverCE group patients compared to 50% in control group, P = 0.001). Myocardial Blush Grading improved to 3 in 11 of study group compared to only 2 of control group patients (P=0.01). Complete ST segment resolution was achieved in 70% of study group compared to 35% of the control group patients (P = 0.047). The six months left ventricular end diastolic dimension and wall motion score index were significantly

lower in the study group (4.97 ± 0.55 cm and 1.41 ± 0.20) compared to control group (5.49 ± 0.36 cm and 1.66 ± 0.16) (P = 0.001 and 0.044 respectively). Six months left ventricular ejection fraction was significantly higher in study group (56.95 ± 6.15 % Vs 52.10 ± 7.57 %) (P = 0.032).

Conclusions: We concluded that manual thrombus extraction with Diver C.E. catheter as an adjunct therapy in primary PCI for STEMI is a simple, easy-to-use, non-time consuming, procedure which is effective in preventing distal embolization and microvascular obstruction improving myocardial tissue level perfusion and left ventricular remodeling at six months.

Key words:  STEMI, Primary PCI, Manual thrombus aspiration, Diver CE.

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