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Aspiration Thrombectomy in STEMI — EECC MCQ

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ModerateCoronary Artery DiseaseAspiration Thrombectomy in STEMIEECC

A 55-year-old man presents with an acute inferior STEMI. During primary PCI, the operator notes that the RCA has a large thrombus burden. What is the current ESC recommendation regarding routine aspiration thrombectomy?

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Correct answer: E — Routine aspiration thrombectomy is not recommended (Class III); it may be considered as a bailout in cases of large residual thrombus after balloon angioplasty

The TOTAL trial demonstrated that routine aspiration thrombectomy during primary PCI did not improve outcomes and was associated with an increased risk of stroke. The 2023 ESC ACS Guidelines recommend against routine aspiration thrombectomy (Class III). However, it may be considered as a bailout strategy (Class IIb) in cases of large residual thrombus burden after initial balloon angioplasty where there is significant risk of distal embolisation. Rheolytic thrombectomy (AngioJet) is also not routinely recommended. The focus should be on achieving optimal stent result with appropriate adjunctive pharmacotherapy.

Reference: ESC (2023): Guidelines for the Management of Acute Coronary Syndromes; TOTAL Trial