Abstract

Risk of cerebrovascular stroke with primary percutaneous coronary intervention using thrombus aspiration device in STEMI with high thrombus burden lesions: A single center experience

Author(s): Ahmed Gaafar, Ahmed Basyouny

Background: Early restoration of coronary flow in STEMI reduces mortality, high thrombus burden has a higher incidence of no-reflow, stent thrombosis, LV dysfunction and mortality, thrombus aspiration can reduce thrombus burden, but recent data suggest higher stroke incidence.

Objectives: We aimed in the study to determine the safety of the thrombus aspiration in high thrombus burden lesions in primary PCI for STEMI patients.

Methods: One hundred patients were divided into two groups: Group 1: Aspiration catheter was used in 46 patients with high thrombus burden, Group 2: 54 Patients with low thrombus burden, was managed with slandered PCI and thrombus aspiration as bailout only. Group A: patients who developed cerebrovascular stroke, Group B: who didn’t develop cerebrovascular stroke. Procedural complications and MACE data were obtained and follow up for stroke incidence for 30 days.

Results: There were no differences between group-1 and group-2, or between group-A and group-B regards ST segment resolution, intra-procedural complications, re-infarction. No differences between group-1 and group-2 regards death and stroke. Group-1 had lower age, higher DM and smoking prevalence, lower EF, and higher wall motion score index (48.76 vs. 53.68, p-value=0.003) (29.6% vs. 54%, p-value=0.012)(58% vs. 33%, p-value=0.011) (47% vs. 51%, p-value 0.018) (1.35 vs. 1.21, p-value=0.0029). Group-A had lower EF, TIMI III flow, higher WMSI, higher no-reflow, and had higher mortality than group-B (34% vs. 50%, p-value=0.0001) (40% vs. 81.3%, p-value=0.0165) (1.65 vs. 1.26, p-value=0.00015) (60% vs. 3%, p-value=0.00001) (40% vs. 2.1%, p-value=0.011) respectively.

Conclusion: Thrombus aspiration didn’t cause a significant increase in stroke rate at 30 days. LV systolic dysfunction is an important risk factor for stroke during and after pPCI irrespective of the method of revascularization. The stroke had higher mortality in pPCI patients.