In PCI, thrombus aspiration is particularly beneficial in which scenario?

• A. In all cases regardless of lesion characteristics.
• B. When there is no thrombus.
• C. For non-thrombotic lesions only.
• D. In thrombotic or high-risk lesions to reduce distal embolization and no-reflow.

Answer: (D)

Thrombus aspiration during PCI aims to lower distal embolization and the no-reflow phenomenon by removing thrombus from the culprit vessel. This approach is most advantageous when there is a substantial thrombus burden or high‑risk thrombotic lesions because taking the clot out reduces debris that could be dislodged during balloon or stent passage, helping to preserve microvascular perfusion. If there is no thrombus or the lesion is non-thrombotic, the benefit is minimal and the procedure can add time or risk without improving outcomes. Therefore, it is particularly beneficial in thrombotic or high‑risk lesions to reduce distal embolization and no-reflow.