Giải quyết gánh nặng huyết khối trong can thiệp ĐMV cấp

MANAGEMENT OF THROMBUS BURDEN IN PRIMARY PCI Ho Hee Hwa Outline  Rationale for Thrombus Aspiration  Clinical Data on Aspiration Thrombectomy  Current Guidelines  Case Examples Acute MI – Plaque rupture Primary PCI Strategy Pharmaco-invasive Drugs Mechanical Thrombus aspiration POBA/Stent Primary PCI Strategy Pharmaco-invasive Drugs Mechanical Thrombus aspiration POBA/Stent Primary PCI Effects of Thromboembolization during Primary PCI No reflow/ slow flow Poor TIMI flow MORTALITY Thrombus Poor MBG Larger Infarct size Primary PCI Strategy Pharmaco-invasive Drugs Mechanical Thrombus aspiration POBA/Stent Thrombus Aspiration Clot Not all epicardial TIMI Grade Flow are the same Overall Mortality with TIMI Grade Flow: 3.7% 5.4% % Mortality P = 0.007 2.9% 0.7% N = 136 Myocardial Perfusion Grade N = 34 Myocardial Perfusion Grade Gibson CM, et al Circulation 2000;101:125-130 N = 278 Myocardial Perfusion Grades 0/1 Activated Platelets TAPAS The “forgotten” benefit of Gp2b/3a inhibitors Burzotta et al European Heart Journal (2009) 30, 2193-2203 Thrombectomy ± IIb/IIIa inhibitors MORTALITY 8% 7.4% P=0.02 6% 5.0% 4.8% 4% 3.3% 2% IIb/IIIa inhib Thrombectomy - IIb/IIIa inhib Thrombectomy + - IIb/IIIa inhib Thrombectomy – + IIb/IIIa inhib Thrombectomy + + Use of Gp2b/3a inhibitors TAPAS % 91 TASTE 16 TOTAL 39 Selective Approach in Thrombus Aspiration  Perform it when the cause of clot formation is due to thromboembolism/hypercoaguable state Case Example A 47 yr old female presented with anterior STEMI Cause: Essential thrombocytosis Selective Approach in Thrombus Aspiration  Perform it when you are considering intracoronary imaging in primary PCI Case Example Coronary Vasculitis TTSH Experience: Thrombus Aspiration in PPCI 80 70 60 50 40 T.A (%) 30 20 10 2010 2011 2012 2013 2014 2015 TTSH Experience  Primary PCI Registry ( 2009-2012)  1268 patients  CVA ( 1%) in 13 patients  Thrombus aspiration ( 71%) ... TMP Grade Normal ground-glass appearance of blush Dye mildly persistent at end of washout Dye strongly persistent at end of washout Gone by next injection Stain present Blush persists on next