Catheterization and Cardiovascular Interventions

Coronary Artery Disease

Procedural success and long-term outcomes of aspiration thrombectomy for the treatment of stent thrombosis

Corresponding Author

Stephen W. Waldo MD

Department of Medicine, Division of Cardiology, University of California, San Francisco, California

Correspondence to: Stephen W. Waldo, 505 Parnassus Ave, Box 0124, San Francisco, CA 94134. E-Mail: [email protected]Search for more papers by this author

Ehrin J. Armstrong MD,

Ehrin J. Armstrong MD

Department of Medicine, Division of Cardiovascular Medicine, University of California, Davis, California

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Khung-Keong Yeo MBBS,

Khung-Keong Yeo MBBS

Department of Medicine, Division of Cardiovascular Medicine, University of California, Davis, California

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Mitul Patel MD,

Mitul Patel MD

Department of Medicine, Division of Cardiovascular Medicine, University of California, San Diego, California

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Ryan Reeves MD,

Ryan Reeves MD

Department of Medicine, Division of Cardiovascular Medicine, University of California, San Diego, California

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John S. MacGregor MD, PhD,

John S. MacGregor MD, PhD

Department of Medicine, Division of Cardiology, University of California, San Francisco, California

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Reginald I. Low MD FSCAI,

Reginald I. Low MD FSCAI

Department of Medicine, Division of Cardiovascular Medicine, University of California, Davis, California

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Ehtisham Mahmud MD, FSCAI,

Ehtisham Mahmud MD, FSCAI

Department of Medicine, Division of Cardiovascular Medicine, University of California, San Diego, California

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Jason H. Rogers MD, FSCAI,

Jason H. Rogers MD, FSCAI

Department of Medicine, Division of Cardiovascular Medicine, University of California, Davis, California

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Kendrick Shunk MD, PhD, FSCAI,

Kendrick Shunk MD, PhD, FSCAI

Department of Medicine, Division of Cardiology, University of California, San Francisco, California

Department of Medicine, Veterans Affairs Medical Center, San Francisco, California

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Stephen W. Waldo MD,

Corresponding Author

Stephen W. Waldo MD

Department of Medicine, Division of Cardiology, University of California, San Francisco, California

Correspondence to: Stephen W. Waldo, 505 Parnassus Ave, Box 0124, San Francisco, CA 94134. E-Mail: [email protected]Search for more papers by this author

Ehrin J. Armstrong MD,

Ehrin J. Armstrong MD

Department of Medicine, Division of Cardiovascular Medicine, University of California, Davis, California

Search for more papers by this author

Khung-Keong Yeo MBBS,

Khung-Keong Yeo MBBS

Department of Medicine, Division of Cardiovascular Medicine, University of California, Davis, California

Search for more papers by this author

Mitul Patel MD,

Mitul Patel MD

Department of Medicine, Division of Cardiovascular Medicine, University of California, San Diego, California

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Ryan Reeves MD,

Ryan Reeves MD

Department of Medicine, Division of Cardiovascular Medicine, University of California, San Diego, California

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John S. MacGregor MD, PhD,

John S. MacGregor MD, PhD

Department of Medicine, Division of Cardiology, University of California, San Francisco, California

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Reginald I. Low MD FSCAI,

Reginald I. Low MD FSCAI

Department of Medicine, Division of Cardiovascular Medicine, University of California, Davis, California

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Ehtisham Mahmud MD, FSCAI,

Ehtisham Mahmud MD, FSCAI

Department of Medicine, Division of Cardiovascular Medicine, University of California, San Diego, California

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Jason H. Rogers MD, FSCAI,

Jason H. Rogers MD, FSCAI

Department of Medicine, Division of Cardiovascular Medicine, University of California, Davis, California

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Kendrick Shunk MD, PhD, FSCAI,

Kendrick Shunk MD, PhD, FSCAI

Department of Medicine, Division of Cardiology, University of California, San Francisco, California

Department of Medicine, Veterans Affairs Medical Center, San Francisco, California

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First published: 22 May 2013

https://doi.org/10.1002/ccd.25007

Citations: 12

Disclosures: Dr. Low is on the advisory board of Abbott Vascular and Boston Scientific. Dr. Rogers is a consultant for Volcano, Medtronic, and Boston Scientific. Dr. Mahmud is on the Speakers Bureau for Medtronic and Eli Lilly, is a consultant for Eli Lilly and has research support from Boston Scientific, Abbott Vascular, Accumetrics and Sanofi Aventis. Dr. Shunk receives institutional research support from Abbott Vascular, Gilead, InfraRedx, and Siemens Medical Systems. The other authors report no disclosures.

Conflict of interest: Nothing to report.

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Abstract

Background

Stent thrombosis (ST) is associated with a significant burden of coronary thrombus and potential microvascular obstruction. Aspiration thrombectomy may decrease the extent of microvascular obstruction in patients with acute myocardial infarction but its role in the treatment of ST is uncertain. The present study sought to evaluate the association between aspiration thrombectomy, procedural success and long-term outcomes among patients presenting with ST.

Methods

In a multicenter cohort of patients with definite ST, procedural success, long-term mortality, and major adverse cardiovascular events (death, stroke, re-infarction, revascularization) were ascertained. Propensity weighting was used to determine the association between aspiration thrombectomy and long-term outcomes.

Results

A total of 205 patients with ST were identified. Among these, 115 (56%) patients underwent adjunctive aspiration thrombectomy during percutaneous coronary intervention. Patients undergoing aspiration thrombectomy were more likely to present with ST-elevation myocardial infarction (75% vs. 52%, P < 0.003) and require hemodynamic support (19% vs. 10%, P = 0.07). Aspiration thrombectomy was associated with improved procedural outcomes including postprocedural TIMI 3 flow, resulting in higher angiographic and procedural success (each 96% vs. 83%, P < 0.001). Despite improved angiographic outcomes, the use of aspiration thrombectomy was not associated with a difference in long-term mortality (adjusted HR 0.99, 95% CI 0.44–2.24) or major adverse cardiovascular events (adjusted HR 1.06, 95% CI 0.45–2.48).

Conclusions

Aspiration thrombectomy is associated with improved coronary flow and procedural success but is not associated with improved long-term outcomes among patients undergoing percutaneous intervention for definite ST.

Supporting Information

REFERENCES

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Citing Literature

Volume82, Issue7

1 December 2013

Pages 1048-1053

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Procedural success and long-term outcomes of aspiration thrombectomy for the treatment of stent thrombosis

Abstract

Background

Methods

Results

Conclusions

Supporting Information

REFERENCES

Citing Literature

References

Information

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Procedural success and long-term outcomes of aspiration thrombectomy for the treatment of stent thrombosis

Abstract

Background

Methods

Results

Conclusions

Supporting Information

REFERENCES

Citing Literature

References

Related

Information