Manual Thrombectomy Raises Stroke Risk

The practice of using a syringe to suck a blood clot out of a coronary artery when a heart attack patient is undergoing angioplasty is common. But a study of 10,000 patients showed this manual thrombectomy procedure was associated with a higher rate of strokes in these patients.

Suctioning blood clots from heart arteries prior to angioplasty following a heart attack is not always good idea, a Canadian study found.

In a study presented March 16 at the American College of Cardiology meeting in San Diego, CA, researchers said these manual thrombectomy procedures—in which a surgeon uses a tube attached to a syringe to remove the clot--appear to increase the risk of stroke.

About 20% of angioplasty patients get manual thrombectomy, Sanjit Jolly, MD, an interventional cardiologist at McMaster University, Hamilton, Ontario said. Mechanical thrombectomy, in which a machine creates the suction to extract the clot, was not evaluated, he said.

The manual procedure should only be used “as a bailout therapy” when initial angioplasty does not open the culprit artery.

“Clearly for patients who fail an initial angioplasty attempt, thrombectomy may be very important and is really the only way to open up the artery,” Jolly said.

The study involved 87 hospitals in 20 countries. Researchers looked at results for 10,000 patients who had angioplasty after a severe heart attack.

Half the patients got angioplasty alone and the others had manual thrombectomy in addition to angioplasty.

At 6 months Jolly and colleagues found no significant differences in the two groups’ rates of death, subsequent heart attack, cardiogenic shock and severe heart failure.

But there was a significant increase in stroke in the manual thrombectomy group (0.7% vs. 0.3% in the group that had angioplasty only.

For the 33 patients in the study’s thrombectomy group who had strokes within 30 days of the procedure, that may have indicated that a clot escaped during the attempt to suck it out with the syringe and migrated to the brain. But there were also 16 patients in the other group (no thrombectomy) who had strokes, so the finding may have been due to chance, he said.