Am J Cardiovasc Dis 2013;3(3):146-157
Original Article
Manual vs mechanical thrombectomy during PCI for STEMI: a
comprehensive direct and adjusted indirect meta-analysis of randomized
trials
Eliano Pio Navarese, Giuseppe Tarantini, Giuseppe Musumeci, Massimo Napodano, Roberta Rossini, Mariusz
Kowalewski, Anna Szczesniak, Michalina Kołodziejczak, Jacek Kubica
Department of Cardiology and Internal Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University,
Bydgoszcz, Poland; Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua,
Italy; Department of Cardiovascular Medicine, Ospedali Riuniti, Bergamo, Italy
Received June 16, 2013; Accepted July 27, 2013; Epub August 16, 2013; Published August 30, 2013
Abstract: Thrombus removal by manual thrombectomy improves coronary flow and myocardial perfusion after
percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI); growing interest is on
mechanical devices for thrombectomy which may allow a larger thrombus removal as compared to manual devices. We
aimed to perform the first direct and adjusted indirect meta-analysis of studies on manual and mechanical thrombectomy
in PCI for STEMI. Methods: The literature was scanned for direct and indirect randomized comparisons between manual
and/or mechanical thrombectomy and/or placebo by formal searches of electronic databases from November 1994 to June
2013. Clinical and procedural endpoints were selected. Results: Three studies directly comparing (2 RCTs and 1 non-
randomized; N = 513) and 21 RCTs (N = 4514) indirectly comparing the two strategies were included in the meta-analysis.
The direct meta-analysis showed comparable rates of survival (p = 0.88), re-infarction (MI) (p = 0.84) and procedural
outcomes between the two strategies; direct evidence was however limited in number of enrolled patients. The indirect
meta-analysis showed a superior reduction in mortality with manual thrombectomy compared to mechanical
thrombectomy in the overall analysis (p = 0.01); by excluding trials with low percentage of patients with intracoronary
thrombus (< 50%) at baseline, the two strategies were comparable in survival, but mechanical thrombectomy was
associated with a significant reduction in re-MI (p < 0.001) and stroke (p = 0.04). Conclusions: This meta-analysis lends
support to mechanical thrombectomy in the population with high thrombus burden only where, compared to manual
thrombectomy, it is likely to provide higher benefits in reduction of re-MI and stroke. (AJCD1306005).
Keywords: Mechanical thrombectomy, manual thrombectomy, meta-analysis
Address correspondence to: Dr. Eliano Pio Navarese, Department of Cardiology and Internal Medicine, Ludwik Rydygier
Collegium Medicum, Nicolaus Copernicus University, Sklodowskiej-Curie Street No 9, 85-094 Bydgoszcz, Poland. Tel: +48
52 585 40 23; Fax: +48 52 585 40 24; E-mail: eliano.navarese@alice.it
Original Article
Manual vs mechanical thrombectomy during PCI for STEMI: a
comprehensive direct and adjusted indirect meta-analysis of randomized
trials
Eliano Pio Navarese, Giuseppe Tarantini, Giuseppe Musumeci, Massimo Napodano, Roberta Rossini, Mariusz
Kowalewski, Anna Szczesniak, Michalina Kołodziejczak, Jacek Kubica
Department of Cardiology and Internal Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University,
Bydgoszcz, Poland; Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua,
Italy; Department of Cardiovascular Medicine, Ospedali Riuniti, Bergamo, Italy
Received June 16, 2013; Accepted July 27, 2013; Epub August 16, 2013; Published August 30, 2013
Abstract: Thrombus removal by manual thrombectomy improves coronary flow and myocardial perfusion after
percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI); growing interest is on
mechanical devices for thrombectomy which may allow a larger thrombus removal as compared to manual devices. We
aimed to perform the first direct and adjusted indirect meta-analysis of studies on manual and mechanical thrombectomy
in PCI for STEMI. Methods: The literature was scanned for direct and indirect randomized comparisons between manual
and/or mechanical thrombectomy and/or placebo by formal searches of electronic databases from November 1994 to June
2013. Clinical and procedural endpoints were selected. Results: Three studies directly comparing (2 RCTs and 1 non-
randomized; N = 513) and 21 RCTs (N = 4514) indirectly comparing the two strategies were included in the meta-analysis.
The direct meta-analysis showed comparable rates of survival (p = 0.88), re-infarction (MI) (p = 0.84) and procedural
outcomes between the two strategies; direct evidence was however limited in number of enrolled patients. The indirect
meta-analysis showed a superior reduction in mortality with manual thrombectomy compared to mechanical
thrombectomy in the overall analysis (p = 0.01); by excluding trials with low percentage of patients with intracoronary
thrombus (< 50%) at baseline, the two strategies were comparable in survival, but mechanical thrombectomy was
associated with a significant reduction in re-MI (p < 0.001) and stroke (p = 0.04). Conclusions: This meta-analysis lends
support to mechanical thrombectomy in the population with high thrombus burden only where, compared to manual
thrombectomy, it is likely to provide higher benefits in reduction of re-MI and stroke. (AJCD1306005).
Keywords: Mechanical thrombectomy, manual thrombectomy, meta-analysis
Address correspondence to: Dr. Eliano Pio Navarese, Department of Cardiology and Internal Medicine, Ludwik Rydygier
Collegium Medicum, Nicolaus Copernicus University, Sklodowskiej-Curie Street No 9, 85-094 Bydgoszcz, Poland. Tel: +48
52 585 40 23; Fax: +48 52 585 40 24; E-mail: eliano.navarese@alice.it
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