In ST elevation ACS the preferred treatment is primary PCI. However, one its limitations is thrombus presence and its distal embolization, which threatens microcirculation perfusion and is therefore associated to ventricular function deterioration and bad evolution.
Manual thrombus aspiration has been tested in different studies but the problem remains unsolved; mechanical thrombectomy might be a solution to this complication, so difficult to handle.
The CHEETAH study (prospective, multicenter) included 400 patients with ST-ACS presenting within 12 hrs. of symptom onset treated with mechanical thrombectomy with CAT RX Aspiration System (Penumbra Inc, Alameda CA).
Primary end point was a composite of cardiovascular death, repeat MI, cardiogenic shock or new class IV cardiac failure at 30 days.
Mean age was 60, most patients were men, 25% were diabetic, 2% had prior CABG and 20% prior PCI.
Most patients were in Killip class I-II. Compromised arteries were the right coronary, in half of patients, followed by the anterior descending and, less frequently, the circumflex.
Read also: ACC 2023 | Subanalysis of the REVIVED-BICS Study2.
Final rates of TIMI 0 was 99.50%, TIMI flow 3, 97.50% and myocardial blush grade 3 was 99.75%, with no device complications.
Primary end point occurred in 3.6% of cases (95% CI, 2.0–6.0%) compared against the historical rate of 6.1% (Pnoninferiority <0.001).
At 30 days, cardiovascular mortality was 0.51%, stroke 0.77%, major bleeding 1%.
Conclusion
Mechanical aspiration before PCI in acute coronary syndrome with high thrombus burden was safe, and was associated to high thrombus removal with flow restauration and normal perfusion on final angiography.
Dr. Carlos Fava.
Member of the Editorial Board ofSOLACI.org.
Original Title: Sustained Mechanical Aspiration Thrombectomy for High Thrombus Burden Coronary Vessel Occlusion: The Multicenter CHEETAH Study.
Reference: S. Jay Mathews, et al. Circ Cardiovasc Interv. 2023;16:e012433. DOI: 10.1161/CIRCINTERVENTIONS.122.012433.
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