Primary angioplasty Thrombectomy and choice of stents

1. Primary angioplastyThrombectomy and choice of stents Adam de Belder Sussex Cardiac Centre Brighton UK ACI 2011

2. No conflicts of interest

5. Myocardial blush grade, EF and mortality Zijlstra et al

6. IT SEEMS LOGICAL TO ARGUE THAT ANY PROCEDURE THAT LEADS TO OPTIMAL MYOCARDIAL BLUSH GRADE SHOULD BE STRONGLY CONSIDERED THROMBECTOMY - FOR EVERY CASE OF STEMI?

9. ..THE ARGUMENT THAT THROMBECTOMY PROLONGS DTB TIMES DOES NOT WASH..

22. Are there non-believers? • …oh yes

23. Thrombectomy: beneficial (if ever) only in highly selected patients Prof. Imad Sheiban University of Turin, Turin, Italy

25. PROF. SHEIBAN’S TAKE HOME MESSAGES Active thrombectomy is too expensive and not risk-beneficial and thus should be discouraged in most cases Manual thrombectomy can be attempted in selected cases with large thrombus burden in proximal lesions were lack of support or risk of dissection are not major issues Most cases of STEMI can be managed with a highly selective use of manual thrombectomy, keeping balloon and stenting as the procedural workhorses

28. ESC guidelines – STEMI

30. The trial that needs to be done is: Routine thrombectomy Vs Selective operator-choice thrombectomy

31. Which stent for STEMI?

50. AHA guidelines 2009