Thrombus aspiration during primary angioplasty

Primary angioplasty is currently the best method for treating persons with acute ST elevation myocardial infarction presenting during the window period. Embolisation of atherothrombotic material during primary angioplasty often leads to obstructionof microvasculature and the well known ‘slow flow phenomenon’. Various methods have been evaluated for reducing the chance for microvascular obstruction during primary angioplasty. Currently one of the popular methods is to aspirate the thrombus within the lumen of the artery and remove it. Thrombus aspiration produces better reperfusion and clinical outcomes. Aspiration is often considered when there is a visible thrombus on angiography. The device is introduced soon after the occlusive lesion is crossed by the guide wire.  The aspiration catheter is introduced into the thrombus containing region under continuous aspiration. The whole unit is then withdrawn over the guide wire  and the aspirated thrombus taken out. Care should be taken to avoid spillage of the thrombus into major proximal branches which can have catastrophic results. Negative suction is maintained while withdrawing the catheter. Care should be taken to prevent undue advancement of the guide catheter which may occur during this withdrawal process. NEJM article documenting the utility of thrombus aspiration is available here: http://content.nejm.org/cgi/content/full/358/6/557

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