Thrombus aspiration during percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is said to reduce PCI-induced distal occlusion.1-3 In an attempt to enhance its effectiveness, thrombus aspiration is often coupled with glycoprotein IIb/IIIa (GpIIb/IIIa) inhibitors, though conflicting results on this strategy have been reported so far.4-5 Indeed, GP IIb/IIIa antagonists inhibits the final common pathway that leads to platelet aggregation and leucocyte plugging which are the main components of fresh thrombi,6 but are unable to modify the morphologic characteristics of older thrombi (i.e., lytic changes and organization), which are found in nearly ¿50% of STEMI patients.7,8 Fibrinolytic agents, conversely, can weaken the structure of older thrombi and therefore have the potential to facilitate manual aspiration.9 Accordingly, we designed the DISSOLUTION (Delivery of thrombolytIcs before thrombectomy in patientS with ST-elevatiOn myocardiaL infarction Undergoing primary percuTaneous coronary interventION) trial, a prospective, randomized, single-blind trial in order to evaluate the hypothesis that intrathrombus delivery of thrombolysis prior to manual thrombectomy can enhance the efficacy of thrombus aspiration in primary PCI.
