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[Comment] Coronary thrombus aspiration: a lesson for clinical medicine

ST-elevation myocardial infarction (STEMI) is most often caused by plaque rupture associated with thrombus formation.1 Embolisation of thrombus is associated with a poor prognosis, and it seems logical that aspiration of thrombus material before coronary stenting should improve outcome. In The Lancet, Sanjit Jolly and colleagues2 report the 1-year results of TOTAL, a multicentre randomised trial of routine manual thrombectomy in 10 732 patients with STEMI, in which patients were randomly assigned to thrombectomy followed by percutaneous coronary intervention (PCI) or PCI alone.