RETRIEVE-AMI
Research type
Research Study
Full title
STENT RETRIEVER THROMBECTOMY FOR THROMBUS BURDEN REDUCTION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION – RETRIEVE–AMI study
IRAS ID
294665
Contact name
Giovanni Luigi De Maria
Contact email
Sponsor organisation
Oxford University Hospitals NHS Foundation Trust
Duration of Study in the UK
3 years, 0 months, 2 days
Research summary
Heart attacks are caused by the sudden formation of a clot inside a diseased coronary artery which reduces blood flow beyond the blockage site. During conventional treatment of the blockage with what is known as a stent; a stainless-steel tub that keeps the artery open, the clot that has formed is disrupted and is pushed further down leading to damage in smaller blood vessels supplying the heart muscle. This additional damage can lead to long-term heart muscle damage influencing recovery and wellbeing. The original concept that was tested to prevent this ‘clot shower’ was that of a suction device to withdraw the clot before stenting. However, this approach has not translated to patient benefit.
Amongst the reasons put forward for the inefficacy of the suction device was that it does not remove the entire clot as it does not interact with it. A new device that physically interacts with the clot and traps it before pulling it out - the stent retriever - is now routinely used in stroke therapy to remove clots in the arteries supplying the brain. This device has been successfully used as a last resort to remove clots in a small number of heart attacks. We hypothesize that stent retriever therapy will be more effective in clot removal than the current standard of care; suction or stenting. To study this, we propose the RETRIEVE-AMI randomised controlled trial.
Lay summary of study results: When someone has a severe heart attack (called STEMI), doctors try to quickly open up the blocked artery using a procedure called PCI. However, if there is a lot of blood clot (thrombus) blocking the artery, it can make it harder for blood to flow properly, even after opening the artery.Traditionally, doctors have used a method called manual aspiration (MA) to try to remove these clots, but this doesn’t always work well. A new technique, called stent-retriever thrombectomy (SRT), has worked well for removing clots in strokes, so researchers wanted to see if it could help in heart attacks too.
In this study, 81 patients with large clots in their heart arteries were split into groups: some had PCI alone, some had PCI plus MA, and some had PCI plus SRT. The researchers measured how much clot was present before and after treatment.
They found that both MA and SRT helped reduce the amount of clot before placing a stent, and using SRT was safe with no major complications. While SRT removed larger clots than MA, the overall clot amount before stenting was similar across all groups.
The study shows that SRT is a feasible and safe option for treating large clots during heart attacks, but bigger studies are needed to better compare these methods and confirm the benefits
REC name
South Central - Oxford C Research Ethics Committee
REC reference
21/SC/0220
Date of REC Opinion
3 Nov 2021
REC opinion
Further Information Favourable Opinion