Thrombus aspiration in primary percutaneous coronary intervention how to manage failure.

More than 30 years ago, thrombotic occlusion of a coronary artery was identified as the pathophysiological mechanism causing myocardial infarction (1). Mechanical and/or thrombolytic reperfusion has subsequently become the standard of care for patients with ST-segment elevation myocardial infarction (STEMI). However, reperfusion of the epicardial coronary artery does not guarantee reperfusion at the myocardial tissue level. Distal embolization of atherothrombotic debris after primary percutaneous coronary intervention (PCI) contributes significantly to the occurrence of microvascular obstruction, which occurs in 15% to 70% of cases, depending on the sensitivity of the diagnostic modality used, and is associated with a worse prognosis (2,3).