Coronary manual thrombectomy - a 12-year single centre experience

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Coronary manual thrombectomy is not routinely recommended, due to the risk of stroke, as supported by some dedicated clinical trials. It is, however, a simple and delicate technique that gives the opportunity to improve angioplasty results by decreasing thrombus burden and potentially improving stent apposition and decreasing no-reflow phenomenon, protecting coronary microcirculation.

To describe a single-centre experience on coronary manual thrombectomy, regarding clinical context, anatomic/technical features, procedure success and in-hospital occurrence of stroke.

Retrospective study of procedures in which coronary manual thrombectomy was performed from 2009 to 2021. Procedure and patient characteristics were analyzed and related with hospital records of new stroke diagnosis.

Manual thrombectommy was performed on 1136 procedures, in 1111 patients (77% male). As expected, the vast majority of cases were acute coronary syndromes: STEMI (1031 cases; 90,8%) and NSTEMI (78; 6,9%). The device used was predominantly 6F (81,7%). Most frequent reference diameters were 3,0mm (529; 46,6%) and 3,5mm (244; 21,5%). The vessel was initially completely occluded in about two thirds of the cases (747; 65,8%) and the left anterior descending artery was the most frequent culprit (541; 47,7%), followed by the right coronary (386; 33,9%). Revascularization was considered completely successful in 1017 (89,5%) of cases. There were no cases of new stroke diagnosis during admission in these patients.

Coronary manual thrombectomy should not be routinely performed, as recommended by international guidelines. However, fear of stroke should not hamper its use whenever the benefits seem clear, such as the presence of a flow-limiting thrombus in a culprit artery, with a retrievable size and good catheter engagement of the coronary artery. In this relatively large sample, we report a good single centre experience with this technique, with no clinical stroke occurrence during admission.