The key word for successful primary PCI is
- Suction & Aspiration of thrombus with micro catheters like export catheters
- One can do away with a stent during primary PCI but can never do away aspiration
- Distal protection as concept is rapidly dying out as we aim to remove all the thrombus .
Tips for effective thrombus aspiration
- Apply continuous negative pressure once catheter reaches the thrombus do not release it till you enter back into the guide.
- Make sure you are sucking only blood products not the endothelium
- Watch out for side branch spill over.
- 7F sheath 7F catheter ideal for aspirating with a micro catheter
- Please be informed some thrombus require more negative pressure especially in the late presenters of STEMI
* During dire emergency when you do not have a specialized suction catheter do not hesitate to push even a diagnostic catheter into the coronary .We have saved few lives !
Crazy questions in primary PCI ( or Is it futuristic )
Can we connect the suction apparatus into LAD micro catheter ?
Do we have camera guided suction catheter ?
Can you flush the thrombus if you are not succeeding in aspiration ?
Is ultrasonic desiccation of thrombus possible ?
Acknowledgement
Some of the tips were gathered from the recently concluded India Live 2012 conference in New Delhi .
Dr.S.Venkatesan MD 