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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\n      \u003Ch2\u003ESummary\u003C\/h2\u003E\n      \u003Cp id=\u0022p-1\u0022\u003EThis article discusses a retrospective study that investigated the impact of thrombus burden on clinical outcomes in 812 consecutive patients who were treated with drug-eluting stents.\u003C\/p\u003E\n   \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ethrombotic disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emyocardial infarction\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n      \u003Cp id=\u0022p-2\u0022\u003E\u201cThe major procedural difference between elective primary percutaneous coronary intervention (PCI) and an ST-segment elevation myocardial infarction (STEMI) intervention is thrombus, and you will encounter thrombus,\u201d warned Sameer Mehta, MD, University of Miami, Miami, Florida, USA. \u201cThe major component of intervention for STEMI is understanding thrombus and how to manage it effectively.\u201d\u003C\/p\u003E\n      \u003Cp id=\u0022p-3\u0022\u003EIn a retrospective study that investigated the impact of thrombus burden on clinical outcomes in 812 consecutive patients who were treated with drug-eluting stents (DES), large thrombus burden (defined as thrombus burden \u22652 vessel diameters) was an independent predictor of mortality (HR, 1.76; p=0.023) and major adverse cardiac events (MACE; HR, 1.88; p=0.001) [Sianos G et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2007]. Small thrombus burden was associated with less distal emboli and incidence of no reflow, greater final TIMI 3 flow, and higher rates of myocardial blush grade 3. The initial amount of thrombus impacted both acute and long-term outcomes.\u003C\/p\u003E\n      \u003Cp id=\u0022p-4\u0022\u003ESvilaas and colleagues randomly assigned 1071 patients to receive manual thrombus aspiration or conventional PCI before undergoing coronary angiography and found that even minimal aspiration resulted in better reperfusion and clinical outcomes than conventional PCI, irrespective of clinical and angiographic characteristics at baseline [Svilaas T et al. \u003Cem\u003EN Eng J Med\u003C\/em\u003E 2008]. Patients who were pretreated with a manual thrombectomy device before PCI had better epicardial and myocardial perfusion, less distal embolization, and significant reduction in 30-day mortality (p=0.003). Thus, if not contraindicated, adjunctive manual thrombectomy devices should be routinely used in STEMI patients who are undergoing primary angioplasty [De Luca G et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2008]. Both the United States and European guidelines support the use of aspiration thrombectomy for patients who are undergoing PCI for STEMI\u003C\/p\u003E\n      \u003Cp id=\u0022p-5\u0022\u003EThe Mehta Classification [Mehta S et al. \u003Cem\u003ECath Lab Digest\u003C\/em\u003E 2011] provides a selective strategy for thrombus management, based upon the thrombus grade. The first step is to identify the grade of thrombus using a scale, where Grade 0 represents no thrombus and Grade 5 represents complete occlusion of the vessel. For Grades 0 and 1, direct stenting is possible. For Grades 2 and 3, aspiration thrombectomy is recommended, followed by PCI. Passes with the aspiration catheters should be made throughout the entire length of the thrombus until there is no angiographic evidence remaining; often, just 2 passes is sufficient. For Grades 4 and 5, the use of a mechanical approach (eg, the AngioJet\u00ae or Clearway\u2122) is recommended. The rheolytic thrombectomy device is effective for debulking voluminous thrombi. If AngioJet devices are not available, a default catheter, such as an aspiration catheter, may be used for high-grade thrombus. Early upstream antiplatelet pharmacology must be incorporated as well.\u003C\/p\u003E\n      \u003Cp id=\u0022p-6\u0022\u003EIn summary, said Dr. Mehta, \u201cto eliminate the thrombus, you must first identify the grade of thrombus. The thrombus-graded approach to using these devices, as in the SINCERE (Single Individual Community Experience Registry for Primary PCI) database, produces excellent clinical results.\u201d\u003C\/p\u003E\n   \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/6\/34.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn0uq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}