Should the practicing interventionalist use manual aspiration systematically in all patients or only in selected patients with an angiographically obvious thrombotic burden?

A best-evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, should the practicing interventionalist use manual aspiration systematically in all patients undergoing percutaneous coronary intervention (PCI) or only in selected patients with an angiographically obvious thrombotic burden? Altogether, 198 papers were found using the reported search, of which nine represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that the evidence demonstrates that clinical and angiographic outcomes with respect to manual thrombectomy are similar and encouraging for patients with both angiographic evidence of thrombus burden and those in whom it is used routinely. In addition, there is no significant increase in major adverse cardiac events when routine use of manual aspiration is adopted as opposed to reserving its use for those patients with angiographic evidence of thrombus. In summary, the evidence supports the use of routine systematic manual aspiration in all patients undergoing primary PCI for ST-elevation myocardial infarction.