Aktueller Stellenwert der Thrombektomie bei primärer PCI

Abstract

Impaired myocardial perfusion after PCI is a common situation in patients with ST-elevation myocardial infarction (STEMI). It is caused by embolization of thrombotic material followed by microvascular obstruction. Removal of the thrombus by manual thrombus aspiration could prevent peripheral embolization and reduce infarct size. Several smaller studies showed improvement in surrogate parameters for myocardial perfusion such as TIMI flow, myocardial blush grade and ST-segment resolution in patients with STEMI undergoing routine thrombus aspiration. These effects however, did not translate into reduction of hard clinical endpoints (death, recurrent myocardial infarction, heart failure) in large randomized trials (TASTE, TOTAL). According to current knowledge thrombus aspiration should not be performed routinely in all STEMI patients. It should still be considered in selected patients especially with high thrombus burden presenting early to optimize results of the intervention.

Kernaussagen

• Die primäre PCI ist die Standardtherapie des akuten STEMI. Eine zusätzliche manuelle Thrombusaspiration kann die Koronarperfusion verbessern.

• In großen randomisierten Studien zeigte sich kein klinischer Vorteil einer routinemäßigen Thrombektomie.

• Die Thrombektomie war in einigen Studien mit erhöhtem Schlaganfallrisiko assoziiert. Weil dieser Zusammenhang jedoch nicht periprozedural war, ist die Relevanz dieser Assoziation bisher unklar.

• Laut aktuellen Empfehlungen sollte die Thrombektomie bei selektierten STEMI-Patienten (vor allem mit hoher Thrombuslast) angewendet werden.

• Literatur

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