Primary angioplastyPrimary angioplastyThrombectomy and choice of Thrombectomy and choice of

stentsstents

Adam de BelderAdam de Belder

Sussex Cardiac CentreSussex Cardiac Centre

Brighton UKBrighton UK

ACI 2011

No conflicts of interestNo conflicts of interest

Zijlstra et al

Myocardial blush grade, EF and mortality

THROMBECTOMY - FOR EVERY CASE OF STEMI?

IT SEEMS LOGICAL TO ARGUE THAT ANY PROCEDURE THAT LEADS TOOPTIMAL MYOCARDIAL BLUSH GRADE SHOULD BE STRONGLY CONSIDERED

..THE ARGUMENT THAT THROMBECTOMY PROLONGS DTB TIMES DOES NOT WASH..

Are there non-believers?Are there non-believers?

……oh yesoh yes

Thrombectomy: Thrombectomy: beneficial (if ever) beneficial (if ever)

only in highly only in highly selected patientsselected patients

Prof. Imad SheibanProf. Imad SheibanUniversity of Turin, Turin, ItalyUniversity of Turin, Turin, Italy

PROF. SHEIBAN’S PROF. SHEIBAN’S TAKE HOME MESSAGESTAKE HOME MESSAGES

Active thrombectomy is too expensive and not Active thrombectomy is too expensive and not risk-beneficial and thus should be discouraged risk-beneficial and thus should be discouraged in most casesin most cases

Manual thrombectomy can be attempted in Manual thrombectomy can be attempted in selected cases with large thrombus burden in selected cases with large thrombus burden in proximal lesions were lack of support or risk of proximal lesions were lack of support or risk of dissection are not major issuesdissection are not major issues

Most cases of STEMI can be managed with a Most cases of STEMI can be managed with a highly selective use of manual thrombectomy, highly selective use of manual thrombectomy, keeping balloon and stenting as the procedural keeping balloon and stenting as the procedural workhorsesworkhorses

ESC guidelines – STEMIESC guidelines – STEMI

The trial that needs to be done is:

Routine thrombectomy

Vs

Selective operator-choice thrombectomy

Which stent for STEMI?Which stent for STEMI?

AHA guidelines 2009

GuidelinesGuidelines

..not an excuse to not use your ..not an excuse to not use your developeddeveloped

intellectual capacity to do the best for intellectual capacity to do the best for your patientsyour patients

ConclusionsConclusions