Ep. 28 Understanding Manual and Mechanical Coronary Thrombectomy in Practice with Dr. Andrew Goldsweig

TAPAS, TASTE, TOTAL. These are the names of clinical trials that re-evaluated the use of manual aspiration thrombectomy in STEMI. In this episode of BackTable Cardiology, host Dr. Sameh Sayfo interviews Dr. Andrew Goldsweig, Director of Cardiovascular Clinical Research at Baystate Medical Center and Chair of the SCAI Standards and Guidelines Committee, about coronary thrombectomy in contemporary PCI. --- This podcast is supported by an educational grant from Cheisi. --- SYNPOSIS Drs. Sayfo and Goldsweig review how evidence from major trials led to a Class III recommendation against routine manual aspiration thrombectomy in STEMI, discuss methodological differences among studies and concerns about stroke reporting, and clarify how selective or bailout use may still have a role in high thrombus-burden cases. Their conversation also covers growing interest in mechanical thrombectomy technologies, the design and limitations of newer device studies, practical considerations that influence adoption, and differing operator approaches to STEMI workflows. They conclude by discussing gaps in evidence, the need for comparative data, and potential future features of next-generation coronary thrombectomy devices. --- TIMESTAMPS 00:00 - Introduction02:51 - Manual vs Mechanical Thrombectomy03:56 - TAPAS, TASTE, and TOTAL Trials10:20 - CHEETAH Trial Breakdown13:05 - Practice Patterns and Billing16:26 - Step by Step STEMI Workflow20:09 - Door to Balloon Reality22:03 - Impella First Strategy24:08 - High Thrombus Scenarios33:30 - Wishlist Catheter Features --- RESOURCES Dr. Sameh Sayfo’s Provider Profilehttps://www.bswhealth.com/physician/sameh-sayf Dr. Andrew Goldsweig’s Provider Profilehttps://www.baystatehealth.org/providers/andrew-m-goldsweig A Prospective, Multicentre, Long-Term Cohort Study in Children, Adolescents and Adults with Seasonal Allergic Rhinitis-Design and Early Results (TAPAS)https://pubmed.ncbi.nlm.nih.gov/40283440/ Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction (TASTE)https://www.nejm.org/doi/full/10.1056/NEJMoa1308789 Randomized Trial of Primary PCI with or without Routine Manual Thrombectomy (TOTAL)https://www.nejm.org/doi/full/10.1056/NEJMoa1415098 CHEETAH Study by Penumbrahttps://www.penumbrainc.com/cheetah-study-results/