20.2 Aspiration thrombectomy step-by-step: Manual of PCI

These are the 9 steps of aspiration thrombectomy during PCI:
1. Select aspiration thrombectomy catheter
2. Prepare catheter
3. Load thrombectomy catheter on guidewire
4. Deliver thrombectomy catheter
5. Aspirate
6. Remove catheter
7. Aspirate guide
8. Examine aspirated material
9. Angiogram

[@jacekklaudel5034]

Catheters used for mechanical thrombectomy in stroke (like 5F Sofia from Microvention) are quite useful for coronary aspiration. Sofia has large inner lumen comparable to Guideliner and is much more trackable (can be advanced wireless) - very soft, highly hydrophilic, with an atraumatic tip as a catheter designed for use in intracranial vessels. We have used it as a bailout for inaccessible and/or refractory thrombus.

[@shangz0216]

Thanks for your educative presentation.

[@Cardiologist89]

Very well explained... thank you sir

[@areenal-taie6836]

Many thanks

[@salahuddinsalahuddin3210]

Thanks. Is it just preferable to advance the aspiration catheter from proximal to the distal vessel or do we have to do it only that way. In some cath labs they place the aspiration catheter distally to the thrombus and than start the aspiration with pulling back the aspiration catheter .
Thanks for the answer, too.

[@manosbrilakis]

Either way seems fine to me with the exception of ostial lesions, where aspiration from distal to proximal may increase the risk of thrombus embolization into the aorta.

[@akadiryildiz1798]

Do you recommend guideliner or deep enagagement to avoid systemic embolization? Thanks.

[@jwilson3985]

We rather routinely use 6F GuideLiner and it’s used much more than dedicated aspiration catheters because GEC inner diameter is significantly larger. Don’t really see a purpose for Export type devices. Just have to make sure guide is deep seated.

[@tuanhoanh1198]

should we remove the Guiding catheter if the blood flow back from guiding catheters gets stuck in combination low or lost monitoring pressure even though we have tried to suck it with syringe?

[@manosbrilakis]

Yes!

[@tuanhoanh1198]

@@manosbrilakis thank you for your response

[@holmes0087]

​@@tuanhoanh1198
Have to remove the whole system i.e. along with guidewire?

[@tuanhoanh1198]

do you think we should revise the guideline for aspiration thrombus for clarifying that aspiration remains viable in PCI, upgrade the aspiration recommendation from current class III to IIb

[@manosbrilakis]

The guidelines give a class III indication for "routine" thrombectomy. But thrombectomy remains important for large thrombus and in case of distal embolization or flow compromise.

[@samratmanna6554]

Which will be good result ? Aspiration starts from distally when we pulling back , or we should start aspiration when we advanacing the catheter from proximal ?

[@manosbrilakis]

Can do it both ways - what is important is to not stop aspiration until the the guide catheter is removed from the guide catheter.

[@salahuddinsalahuddin3210]

@@manosbrilakis until the ASPIRATION catheter is removed from the guide..
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