Thrombus aspiration in primary percutaneous coronary intervention: still a valid option with improved technique in selected patients!

Thrombus aspiration during primary percutaneous coronary intervention (pPCI) has been used to improve myocardial perfusion through a reduction of the thrombotic burden eventually resulting into better clinical outcomes (1,2). After the initial enthusiasm derived from the mortality reduction shown in early randomized and observational studies (3-7), disappointing results have been yielded in more recent larger scale trials testing the routine use of thrombus aspiration in pPCI (8-12). As a consequence, this technique has lost its initial appeal such that it is currently often neglected or even considered as a useless hassle by the interventional cardiologists.