6533b82bfe1ef96bd128e749

RESEARCH PRODUCT

Impact of thrombectomy on distales embolization during ST elevation myocardial infaction

subject

description

Percutaneous primary coronary angioplasty is the cornerstone for acute coronary syndrome with ST segment elevation (STEMI) treatment with proven efficacy to restore flow in culprit coronary artery. A TIMI (thrombolysis in myocardial infarction) 3 flow is generally restored in more than 90 % of patients. However, distal embolization of an angiographically visible thrombus (EDAV) has been identified as one of the major complications of primary angioplasty in STEMI because it limits the effectiveness of myocardial reperfusion and leads to a worse prognosis.Our objective was to determine the frequency of EDAVs during primary angioplasty for STEMI and to identify the determining factors.We evaluated 779 patients, including 560 men (71.9%) suffering from STEMI and treated with primary angioplasty. Thromboaspiration was performed in more than half of the cases (53%). The mean age of the patients was 64.03 ± 14.67 years. EDAVs were frequent (15%). Independent factors related to the occurrence of EDAV were clinical factors such as age > 60 years, female sex, thrombectomy, and culprit right coronary. No criterion from culprit lesion was identified as predictors of EDAV.In thrombectomized patients, EDAVs occurred in 17.41 % of cases. Independent predictor factors of these distal embolisms were right coronary artery target and culprit artery diameter ˃ 3 mm.Since the success of thrombectomy restores coronary flow, we are interested in the relationship between the success of this technique and the occurrence of EDAV. This work showed that the occurrence of EDAV was not related to the syntactic score nor to the success of the thrombectomy but to two angiographic criteria, namely right coronary artery disease and culprit artery diameter greater than 3 mm.These data suggest that right coronary artery is the central component of EDAV occurrence. It is a double bent artery and usually of large caliber. It therefore seems necessary to carry out specific studies on the right coronary artery.