New Insights on Thromboaspiration and Microvascular Resistance in Anterior STEMI

A prospective cohort study in anterior STEMI found that routine thromboaspiration was associated with increased microvascular injury on cardiac MRI, raising concerns that aspiration may impair downstream perfusion and should prompt more selective thrombus management in the cath lab.

Among 460 STEMI patients (58% anterior), 193 (42%) underwent thromboaspiration during primary PCI. Cardiac magnetic resonance (CMR) imaging was performed at day 6 and 3 months to assess infarct size and microvascular obstruction (MVO).

Patients treated with thromboaspiration had significantly greater MVO extent (2.9 ± 4.8 g) compared to those without aspiration (1.4 ± 3.5 g; p=0.001), along with higher MVO incidence (49.2% vs. 35.1%; p=0.002) and larger infarct size (22.2% vs. 17.1% of LV mass; p<0.001).