There are many doubts about the benefit of manual thromboaspiration, not only in terms of improvement of the clinical end point but also the potential risk of stroke. The TOTAL (n = 10732) was a randomized study of routine manual thrombectomy versus angioplasty only in the context of ST segment elevation acute myocardial infarction and failed to show benefit in the primary efficacy end point. Also, a significant increase in the rate of stroke was observed; this substudy of TOTAL seeks to understand these events.
The time when stroke severity occurred and subtype was analyzed. The incidence of stroke occurred within the first 48 hours with a higher rate in the thromboaspiration group (0.3% versus 0.1%) and most of them were ischemic though increased hemorrhagic strokes were also observed. Mortality in patients with this complication was 30.8% versus 3.4% (p <0.0001) in those without stroke.
Conclusion
Given the increased risk of stroke observed with thromboaspiration, future studies should be carefully planned to determine the safety of the procedure.
S. Jolly
2015-05-20
Original title: Stroke in the TOTAL trial: randomised trial of manual aspiration thrombectomy in STEMI.
