Manual Thrombectomy in Myocardial Infarction: Aspiring for Better

A dvances in stent technology, procedural technique, and interventional processes of care have contributed to step-wise improvement in outcomes after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). Beyond early restoration of epicardial blood flow, limiting distal embolization and preserving microcirculatory integrity have been major goals of recent adjunctive device development. The introduction of mechanical thrombectomy devices showed considerable initial promise in meeting these standards. An upfront strategy of thrombus aspiration appeared to facilitate certain aspects of stent deployment by allowing for more-optimal visualization of the culprit lesion, increasing rates of direct stenting, and minimizing postdilatation. These technical advantages were coupled with improvement in surrogate markers of myocardial reperfusion and ventricular function with manual thrombectomy. However, despite its strong theoretical and intuitive basis for incremental value, results from pivotal trials and “real-world” registries of manual thrombectomy have not consistently demonstrated clinical benefits over standard PCI.