Stent-Retriever Thrombectomy in STEMI With Large Thrombus Burden

JACC advances Pub Date : 2025-06-23 DOI:10.1016/j.jacadv.2025.101893

Rafail A. Kotronias MBChB, MSc , Jason L. Walsh MBChB , Stefano Andreaggi MD , Leonardo Portolan MD , Alessandro Maino MD , Federico Marin MD , Jason Chai MBBCh , Ikboljon Sobirov MSc , Muhammad Sheikh MD , Thomas J. Cahill MBBS, DPhil , Andrew J. Lucking MBChB, PhD , Max Costello BSc , Eva Fraile Moreno MScNurs , Vrinda Haridas BNurs , Anisha Shaji BNurs , Hector M. Garcia-Garcia MD, PhD , Keith M. Channon MBChB, MD , Adrian P. Banning MBChB, MD , Jeremy P. Langrish MBBCh, PhD , Giovanni Luigi De Maria MD, PhD

{"title":"Stent-Retriever Thrombectomy in STEMI With Large Thrombus Burden","authors":"Rafail A. Kotronias MBChB, MSc , Jason L. Walsh MBChB , Stefano Andreaggi MD , Leonardo Portolan MD , Alessandro Maino MD , Federico Marin MD , Jason Chai MBBCh , Ikboljon Sobirov MSc , Muhammad Sheikh MD , Thomas J. Cahill MBBS, DPhil , Andrew J. Lucking MBChB, PhD , Max Costello BSc , Eva Fraile Moreno MScNurs , Vrinda Haridas BNurs , Anisha Shaji BNurs , Hector M. Garcia-Garcia MD, PhD , Keith M. Channon MBChB, MD , Adrian P. Banning MBChB, MD , Jeremy P. Langrish MBBCh, PhD , Giovanni Luigi De Maria MD, PhD","doi":"10.1016/j.jacadv.2025.101893","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Percutaneous coronary intervention (PCI) restores epicardial flow in ST-segment elevation myocardial infarction (STEMI), but large thrombus burden (LTB) can impair myocardial perfusion due to embolization. While manual aspiration (MA) devices have limited efficacy in STEMI, the success of stent-retriever thrombectomy (SRT) in stroke suggests it as a promising option for STEMI.</div></div><div><h3>Objectives</h3><div>The RETRIEVE AMI (stent-retriever thrombectomy for thrombus burden reduction in patients with acute myocardial infarction) trial assessed the safety and efficacy of Solitaire X SRT vs Export MA in STEMI patients with LTB.</div></div><div><h3>Methods</h3><div>This single-center study enrolled 81 STEMI patients with LTB (TIMI thrombus grade ≥4) and randomized them to PCI, MA-assisted, or SRT-assisted PCI. The primary endpoint was difference in prestent thrombus volume by optical coherence tomography between SRT and either comparator; coprimary endpoints included device-related target vessel complications and major adverse cardiac and cerebrovascular events through 6 months.</div></div><div><h3>Results</h3><div>SRT was performed in 26 cases (one crossover), and MA in 27. No device-related arterial complications or cerebrovascular events occurred in the SRT arm. Baseline thrombus volume was significantly higher in the SRT group (18.3 mm<sup>3</sup>) compared to MA (7.7 mm<sup>3</sup>) and no modification (9.8 mm<sup>3</sup>; <em>P</em> = 0.04). Prestent thrombus volume was not significantly different between SRT (7.7; IQR: 2.3-18.6) and either MA (4.8; IQR: 1.8-8.4; <em>P</em> = 0.17) or no thrombus modification (9.8; IQR: 4.5-18.1; <em>P</em> = 1.00). Both techniques significantly reduced prestent thrombus burden (SRT: 12.8%; IQR: 4.4%-21.5%; <em>P</em> = 0.016 and MA: 13.0%; IQR: 3.8%-19.4%; <em>P</em> = 0.003) compared to no modification (22.8%; IQR: 10.4%-27.7%). No device-related clinically relevant arterial injury was detected and in-hospital and 6-month major adverse cardiac and cerebrovascular events did not differ between arms.</div></div><div><h3>Conclusions</h3><div>RETRIEVE AMI demonstrates the feasibility of Solitaire X SRT in STEMI with LTB. Prestent thrombus volume was not different between SRT, MA, or no thrombus modification, although SRT extracted larger thrombus volume than MA. Larger multicenter studies using optical coherence tomography-based criteria are needed to minimize variability and enhance comparative assessments.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101893"},"PeriodicalIF":0.0000,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JACC advances","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2772963X25003138","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Percutaneous coronary intervention (PCI) restores epicardial flow in ST-segment elevation myocardial infarction (STEMI), but large thrombus burden (LTB) can impair myocardial perfusion due to embolization. While manual aspiration (MA) devices have limited efficacy in STEMI, the success of stent-retriever thrombectomy (SRT) in stroke suggests it as a promising option for STEMI.

Objectives

The RETRIEVE AMI (stent-retriever thrombectomy for thrombus burden reduction in patients with acute myocardial infarction) trial assessed the safety and efficacy of Solitaire X SRT vs Export MA in STEMI patients with LTB.

Methods

This single-center study enrolled 81 STEMI patients with LTB (TIMI thrombus grade ≥4) and randomized them to PCI, MA-assisted, or SRT-assisted PCI. The primary endpoint was difference in prestent thrombus volume by optical coherence tomography between SRT and either comparator; coprimary endpoints included device-related target vessel complications and major adverse cardiac and cerebrovascular events through 6 months.

Results

SRT was performed in 26 cases (one crossover), and MA in 27. No device-related arterial complications or cerebrovascular events occurred in the SRT arm. Baseline thrombus volume was significantly higher in the SRT group (18.3 mm³) compared to MA (7.7 mm³) and no modification (9.8 mm³; P = 0.04). Prestent thrombus volume was not significantly different between SRT (7.7; IQR: 2.3-18.6) and either MA (4.8; IQR: 1.8-8.4; P = 0.17) or no thrombus modification (9.8; IQR: 4.5-18.1; P = 1.00). Both techniques significantly reduced prestent thrombus burden (SRT: 12.8%; IQR: 4.4%-21.5%; P = 0.016 and MA: 13.0%; IQR: 3.8%-19.4%; P = 0.003) compared to no modification (22.8%; IQR: 10.4%-27.7%). No device-related clinically relevant arterial injury was detected and in-hospital and 6-month major adverse cardiac and cerebrovascular events did not differ between arms.

Conclusions

RETRIEVE AMI demonstrates the feasibility of Solitaire X SRT in STEMI with LTB. Prestent thrombus volume was not different between SRT, MA, or no thrombus modification, although SRT extracted larger thrombus volume than MA. Larger multicenter studies using optical coherence tomography-based criteria are needed to minimize variability and enhance comparative assessments.

查看原文本刊更多论文

支架取栓在STEMI大血栓负担中的应用

背景：经皮冠状动脉介入治疗（PCI）可恢复st段抬高型心肌梗死（STEMI）的心外膜血流，但较大的血栓负担（LTB）可因栓塞而损害心肌灌注。虽然手动抽吸（MA）装置在STEMI中的疗效有限，但支架取栓（SRT）在卒中中的成功表明它是STEMI的一个有希望的选择。目的：RETRIEVE AMI（支架取栓减少急性心肌梗死患者血栓负担）试验评估Solitaire X SRT与Export MA在STEMI合并LTB患者中的安全性和有效性。方法本单中心研究纳入81例STEMI LTB （TIMI血栓分级≥4级）患者，随机分为PCI、ma辅助或srt辅助PCI。主要终点是SRT和任一比较物在光学相干断层扫描上的血栓体积差异；主要终点包括6个月内与器械相关的靶血管并发症和主要的心脑血管不良事件。结果26例（1例交叉）行ssrt， 27例行MA。SRT组未发生与器械相关的动脉并发症或脑血管事件。SRT组的基线血栓体积（18.3 mm3）明显高于MA组（7.7 mm3），且无任何改变(9.8 mm3；P = 0.04)。两组间血栓体积差异无统计学意义(7.7；IQR: 2.3-18.6)和MA (4.8；差:1.8 - -8.4;P = 0.17)或无血栓改变(9.8；差:4.5 - -18.1;P = 1.00)。两种技术都显著降低了现有血栓负担(SRT: 12.8%；差:4.4% - -21.5%;P = 0.016, MA: 13.0%；差:3.8% - -19.4%;P = 0.003)，而未修改(22.8%；差:10.4% - -27.7%)。没有检测到与器械相关的临床相关动脉损伤，住院和6个月的主要心脑血管不良事件在两组之间没有差异。结论retrieve AMI验证了Solitaire X SRT治疗STEMI伴LTB的可行性。尽管SRT提取的血栓体积比MA大，但SRT、MA或没有血栓修饰之间的血栓体积没有差异。需要使用基于光学相干层析成像的标准进行更大规模的多中心研究，以最大限度地减少可变性并加强比较评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

JACC advances Cardiology and Cardiovascular Medicine

CiteScore

1.90

自引率

0.00%

发文量