Aspiration catheters and protection filters

Intracoronary thrombus is frequently encountered during primary percutaneous coronary intervention, especially in patients presenting with an acute ST-segment elevation myocardial infarction. During coronary intervention, the presence of thrombus, as well as subsequent liberation and embolization of the thrombus, is linked with worse clinical outcomes and higher incidence of major adverse cardiac events. Since the late 1990s, various modalities have been developed and carefully examined for optimal management of coronary thrombus while ensuring minimal embolization. Two modalities that have surfaced and gained attention include aspiration thrombectomy catheters and embolic protection devices (EPDs). In this chapter, we will present a comprehensive review of aspiration thrombectomy technology and EPDs. We will also focus on key landmark trials that have shaped our current perception regarding these modalities and how they relate to the management of intracoronary thrombus, prevention of distal embolization, and clinical outcomes.