The impact of successful manual thrombus aspiration on in-stent restenosis after primary PCI: angiographic and clinical follow-up

Objectives This study sought to investigate the impact of successful manual thrombus aspiration on angiographic in-stent restenosis and clinical outcome in patients treated by bare metal stent implantation for ST-segment elevation acute myocardial infarction. Background There are very limited data on the impact of manual thrombus aspiration on the occurrence of in-stent restenosis after bare metal stent implantation. Methods This was a prospective, randomized, single-center study. Patients (N = 60) presenting within 12 h of ST-segment elevation acute myocardial infarction symptom onset were randomized to primary percutaneous coronary intervention (PCI) with (N = 30) or without (N = 30) upfront manual thrombus aspiration using the Export aspiration catheter. All patients underwent control coronary angiography after 6 months. Results Baseline, clinical, and angiographic preprocedural findings did not differ between the two groups. Patients who underwent successful manual thrombus aspiration had significantly higher minimal lumen diameter after 6 months (2.25 +/- 0.90 vs. 1.63 +/- 0.76, P = 0.005), significantly lower percentage diameter stenosis (28.81 vs. 45.03%, P = 0.017), and significantly lower late lumen loss (0.73 +/- 0.84 vs. 1.18 +/- 0.79, P = 0.035). There was a trend for lower rate of major adverse cardiocerebrovascular events such as death, myocardial reinfarction, stroke, and target lesion revascularization in the same group of patients (16.67 vs. 26.67%, P = 0.347). Conclusion Successful upfront manual thrombus aspiration during primary PCI showed beneficial effects on the reduction of in-stent restenosis after bare metal stent implantation compared with standard PCI. Coron Artery Dis 23:487-491 (C) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.