Aspiration thrombectomy for the treatment of acute myocardial infarction in the light of critical analysis of contemporary trials

Objective: The study was aimed at assessing the available data on the efficacy and safety of thromboaspiration in acute coronary syndrome and its prospects for more frequent using in routine clinical practice. Methods: A search was performed in the Medline (PubMed), Cochrane Library and Web of Science databases for the period from 2000 to 2024 using the following keywords: “thrombectomy”, “thrombus aspiration”, “thromboaspiration” and “myocardial infarction”. Randomized controlled trials, prospective cohort and registry studies, and meta-analyses were included in the study, while experimental studies and studies with small samples (less than 50 patients) were excluded. The criteria for the efficacy of thromboaspiration itself were critically analyzed, as well as the impact of the device and its design on the efficacy and safety of thromboaspiration were assessed.Results: Of the 230 search results, 45 original publications that met the selection criteria were included in the review. Most studies assessing the efficacy/safety of therapy did not take into account the fact that 20-30% of thromboaspiration from coronary arteries were technically unsuccessful that is quite enough to underestimate its efficacy.Conclusion: The probable reason for the inconsistent results of thromboaspiration trials is high proportion of cases of technically unsuccessful outcomes related to the failure of extracting thrombotic contents from the aspiration catheter. Thromboaspiration is an etiological method for treating acute coronary artery thrombosis, and optimization of the design of thromboaspiration catheters and surgical techniques can significantly improve its efficacy and fully reveal the potential of this method for treating myocardial infarction. Received 25 September 2024. Revised 29 November 2024. Accepted 2 December 2024. FundingThe study did not have sponsorship. Conflict of interestThe authors declare no conflict of interest. Contribution of the authorsConception and study design: E.S. Gergert, S.E. Pekarskiy,A.E. Baev, M.G. Tarasov, I.V. Suslov, A.A. Gorokhovsky, S.M. Sultanov, Yu.I. BogdanovData collection and analysis: E.S. Gergert, S.E. Pekarskiy,I.V. Suslov, A.A. GorokhovskyDrafting the article: E.S. Gergert, I.V. Suslov, A.A. GorokhovskyCritical revision of the article: E.S. Gergert, S.E. Pekarskiy, A.E. Baev, M.G. Tarasov, I.V. Suslov, A.A. Gorokhovsky, S.M. Sultanov, Yu.I. BogdanovFinal approval of the version to be published: E.S. Gergert, S.E. Pekarskiy, A.E. Baev, M.G. Tarasov, I.V. Suslov, A.A. Gorokhovsky, S.M. Sultanov, Yu.I. Bogdanov