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A comparison of intracoronary treatment strategies for thrombus burden removal during primary percutaneous coronary intervention: a COCTAIL II substudy

Gatto, Lauraa,b; Di Landro, Alessiob; Romagnoli, Enricoa,b; Marco, Valeriab; Russo, Chiarab; Pawlowski, Tomaszg; Versaci, Francescoc; Limbruno, Ugod; Castriota, Faustoe; Di Vito, Lucab; Trivisonno, Antoniof; Prati, Francescoa,b

doi: 10.1097/MCA.0000000000000579
Original Research
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Background Manual thrombus aspiration and local drug delivery of abciximab have been proposed as a strategy to reduce thrombus burden during percutaneous coronary intervention in patients with ST elevation myocardial infarction; however, the effectiveness of these approaches, is uncertain. In this COCTAIL II substudy, we compared the effect of these strategies on prestenting and poststenting thrombus burden assessed by optical coherence tomography.

Patients and methods COCTAIL II trial enrolled patients with ST elevation myocardial infarction randomized to intralesion (IL, by the ClearWay catheter) versus intracoronary (IC, by the guide catheter) abciximab bolus with or without aspiration thrombectomy (AT). The following parameters were used to quantify atherothrombotic burden: thrombus volume (TVol), maximum thrombus area (TA), and thrombus burden (TB). Primary endpoint was the comparison of prestenting TVol after the use of local drug delivery (group IL+IL abciximab plus AT) versus nonlocal drug delivery (group IC abciximab plus AT+IC).

Results The final population consisted of 59 patients undergoing both prestenting and poststenting optical coherence tomography assessment. The amount of thrombus was not significantly different in the groups with local drug delivery of abciximab versus nonlocal drug delivery in both prestenting (TVol: 18.87±26.70 vs. 19.02±18.45; TB: 26.73±12.8 vs. 25.18±13.25; and maximum TA: 59.25±18.84 vs. 53.34±19.30) and poststenting (TVol: 8.46±9.15 vs. 8.05±6.81; TB: 6.68±3.54 vs. 6.24±3.66; and maximum TA: 15.47±7.61 vs. 16.52±11.55) evaluations. A good correlation between thrombus measurements after thrombus removal techniques and intrastent thrombus was observed.

Conclusion Either local drug delivery of abciximab or manual thrombus aspiration showed comparable results in terms of prestenting and poststenting thrombus burden removal.

aSan Giovanni Addolorata Hospital

bCentro per la Lotta Contro L’Infarto – CLI Foundation, Rome

cS. Maria Goretti Hospital, Latina

dMisericordia Hospital, Grosseto

eMaria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola

fOspedale A. Cardarelli, Campobasso, Italy

gCentral Clinical Hospital of the Ministry of Interior, Warsaw, Poland

Correspondence to Francesco Prati, MD, Interventional Cardiology, San Giovanni Addolorata Hospital, Via dell’Amba Aradam, 8, 00184 Rome, Italy Tel/fax: +39 067 705 5330; e-mail: fprati@hsangiovanni.roma.it

Received July 26, 2017

Received in revised form September 22, 2017

Accepted September 26, 2017

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