Thrombus Aspiration and Balloon Pumps in Cardiogenic Shock – What's the Bottom Line? - Dr. Yousif Ahmad

Summary

Yousif Ahmad discusses adjunctive treatments for ACS in the catheter laboratory such as thrombus aspiration and balloon pumps (IABP)

• When and when not to use
• Real benefits and justification for thrombus aspiration and IABP use following clinical trials results

Thrombus aspiration

• Theoretical advantages of thrombus aspiration
  • Reduce Embolisation
  • Reduce thrombus burden
  • Reduce no-reflow
  • Visualise anatomy better
  • Facilitate direct stenting
  • Facilitate shorter stents
• TOTAL - No mortality benefit.  But, numerically small, but significantly small increase in stroke with thrombus aspiration.
• Class III recommendation in USA for routine use of aspiration.  This suggests that it is of no certain benefit, and maybe harmful.  

Intra-arterial balloon pump (IABP)

• Theoretical benefits in cardiogenic shock
  • Decrease afterload
  • Increase diastolic coronary perfusion
  • Augment blood pressure
• Previously considered class I indication for treatment of shock, now (2016) Class III indication.  
• No evidence of benefit in randomised trials
• No evidence of benefit in observational trials