Coronary Clot Plumbing – A New Approach

Interventions for dealing with a heart attack (myocardial infarction, or MI) have developed over the years. After many years when bed rest and anticoagulation were the principal treatments, bypass surgery took the field. Vessels from the chest or leg were grafted into place to bypass the blockage. Later, with coronary artery catheterization, the introduction of balloons to break down the clot became popular. Then stents were left in place to hold the vessel open; in a further development, stents were made that were coated with appropriate chemicals – anticoagulants. Now comes an approach that might have been thought of much earlier – use of suction to remove the clot.

An article in the New England Journal of Medicine describes the method. A guidewire is passed through the clot, and then a small catheter is threaded over the wire and used to aspirate the clot tissue; after aspiration a stent is inserted. A comparative study was done, comparing aspiration-plus-stenting with balloon-plus- stenting in over 1,000 patients. Using various criteria to measure the effectiveness of the two procedures, it was clear that the aspiration method reduced the number of ‘failures’ in restoring circulation to the affected heart muscle and improved the number of patients who had normalization of their ECG. Clinical results at 30 days favored the aspiration group, with lower rates of death (2.1% vs. 4.0%), reinfarction (0.8% vs. 1.9%), and overall adverse events (6.8% vs. 9.4%), but the differences were not statistically significant.

This looks like another step forward in the treatment of heart attack. A minor caveat is that the study was done in one center that had great experience in interventional cardiology. We shall have to see if the approach is equally successful in other hands.