5Fr-compatible thrombosuction in STEMI

G. AmorosoOLVG Amsterdam, The Netherlands

« I have no conflicts of interest to discloseregarding this presentation »

Do we need 5 Fr

How aggressive should thrombosuction be

For many patient is the radial artery smaller than a 6Fr introducer

Downsizing is an effective way to prevent radial occlusion

S Jolly, NEJM 2015

TOTAL Trial Flow and Adherence

S Jolly, NEJM 2015

(CV death, re MI, shock, HF NYHA IV)

S Jolly, NEJM 2015

Subgroup Analysis Primary Outcome

PJ Vlaar, JACC Cardiovasc Int 2008

Diver Invatec = ID 0.062”

Export Medtronic = ID 0.041”

Bigger aspiration area do not achieve better results

Vmax – Stron MedicalEmax - TsunaMed

Export - Medtronic

Pronto LP – Vascular Solutions

5Fr compatible

5.2 Fr compatible

6 Fr compatible

Different tip shapes of aspiration catheters

VMax

EMax

# Case 1

Female, 71 yrs. old, Posterior STEMI GC MM JL 3.5 sheathless 5Fr

Sion Asahi GW, Vmax aspiration catheter

LPL lesion

Direct stenting DES 3.0/18 + 3.0/9, Biotronik Orsiro

Final Result

# Case 2

Male, 71 yrs old, inferior STEMI GC MM JL 3.5 sheathless 5Fr

Occluded RCA distal

Asahi Sion GW, Emax aspiration catheter

Visible (white) thrombus retrieved

Deep seating GC

DES 3.0/18 (Biotronik Orsiro)

Final Result

Conclusions

• 5Fr compatible thrombosuction is feasible in selected patients undergoing primary PCI.

• A patient-tailored “Slender” approach with ad-hoc thrombosuction may be the preferred strategy in STEMI