Thrombus aspiration during percutaneous coronary intervention – Authors' reply

The use of balloon predilatation only in the control group, including patients with thrombosis in myocardial infarction (TlMI) grade 2 and 3 flow before percutaneous coronary intervention, is a flaw because previous studies have shown that direct stenting alone is superior to balloon predilatation f...

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Bibliographic Details
Published in:The Lancet (British edition) 2008, Vol.372 (9643), p.1034-1035
Main Authors: Vlaar, Pieter J, Svilaas, Tone, Zijlstra, Felix
Format: Article
Language:English
Subjects:
Angioplasty
Blood clots
Cardiology
Clinical outcomes
Heart attacks
Internal Medicine
Mortality
Myocardial infarction
Thromboembolism
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Summary:The use of balloon predilatation only in the control group, including patients with thrombosis in myocardial infarction (TlMI) grade 2 and 3 flow before percutaneous coronary intervention, is a flaw because previous studies have shown that direct stenting alone is superior to balloon predilatation followed by stenting in STEMI patients, irrespective of aspiration. In addition to thrombus aspiration, upstream administration of a glycoprotein 11b/ IIIa inhibitor, nicorandil treatment, ischaemic postcondition ing after coronary stenting, and deployment of an embolie protection device are knowntoreducemicrovascularobstruction.2 Periprocedural glycoprotein IIb/ IIIa inhibitors are particularly known to improve microvascular flow and reduce the infarct area after coronary occlusion and reperfusion.3,4 So treatment with glycoprotein IIb/ IIIa inhibitors might be an important confounder in Vlaar and colleagues' analysis.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(08)61436-1