↓ 30 d mortality ↓ Distal embolization ↑ Myocardial Blush 3 ↑TIMI 3 Post De Luca et al. EHJ 2008;29:

↑ Myocardial Blush 3 ↑ ST Resolution ↓ 6 m MACE ↓ 6 m Death Kumbhani et al. JACC 2013;16:

p<0,001

For patients randomized to thrombus aspiration, guidewire passing will be followed by thrombus aspiration with an Export aspiration catheter (Medtronic Inc., Santa Rosa, USA). Continuous manual suction is performed using a proximal-to-distal approach, which is defined as active aspiration during initial passage of the lesion. In lesions that cannot initially be passed with the thrombus aspiration catheter it is permitted to dilate the lesion with an angioplasty balloon up to a maximal nominal diameter size of 2.0 mm and attempt to advance the thrombus aspiration catheter for a second time.

HR 0.94 ( ), P=0.63 Etude construite pour une Mortalité attendue de 6.3 vs 4.8 % Il aurait fallut Pts pour assurer une puissance suffisant

M Akhtar et al. ESC 2013

NEJM 2015

A minimum 6 Fr guiding catheter (minimum internal diameter inches) must be used for patients undergoing thrombectomy. The device should be advanced proximal to target lesion and then aspiration should occur prior to crossing lesion. Operators should attempt to aspirate a minimum of 40 cc of blood. If at any time, aspiration stops suddenly, the device should be removed to check for a large thrombus obstructing lumen. If the thrombectomy catheter does not cross the target lesion, it is recommended that pre-dilatation be performed with a small diameter balloon catheter (≤ 2.00 mm diameter) and that thrombectomy then be re- attempted. Thrombectomy should not be used if there is no significant lesion in target vessel (ie. no need for PCI) or vessel size < 2.0 mm and this should be documented on eCRFs

Incomplete ST resolution 27% Thrombec vs 30% PCI; p< 0,001 Distal embolization 1,3% Thrombec vs 3% PCI; p< 0,001

Puymirat et al. ESC 2013

Svilaas et al. NEJM 2008; 358:

Am J Cardiol 2013

Do a good job !