title: Detection of embolic particles with the Doppler guide wire during coronary intervention in patients with acute myocardial infarction: efficacy of distal protection device.
abstract: OBJECTIVE
  We investigated whether embolic particles could be detected as high-intensity transient signals (HITS) with a Doppler guide wire during percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) We also assessed whether these signals could be reduced using a distal protection (DP) device.
  
  
  BACKGROUND
  Embolization of thrombi and plaque components to the microcirculation is a major complication of PCI in patients with AMI. Embolic particles running in the cerebral artery are detected as HITS by transcranial Doppler ultrasound.
  
  
  METHODS
  We prospectively studied 16 consecutive patients with AMI who underwent direct PCI within 24 h after the onset of symptoms. A PercuSurge GuardWire (MedtronicAVE, Santa Rosa, California) was used as the DP device. Eight patients were randomly assigned to the non-DP group, and the remaining eight were assigned to the DP group. Coronary flow velocity was recorded continuously from before the first balloon inflation to after balloon deflation.
  
  
  RESULTS
  All patients in the non-DP group had HITS detected (12 +/- 9 counts) within five consecutive beats (4 +/- 1 beat) after balloon deflation, but none were detected in any of the patients in the DP group.
  
  
  CONCLUSIONS
  The Doppler guide wire can be used to visually detect and count emboli as HITS, and the DP device is effective for prevention of distal embolization.
authors.affiliation: Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan.
authors.forename: Atsunori
authors.initials: A
authors.lastname: Okamura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.forename: Katsuomi
authors.initials: K
authors.lastname: Iwakura
authors.forename: Shigeo
authors.initials: S
authors.lastname: Kawano
authors.forename: Koichi
authors.initials: K
authors.lastname: Inoue
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Maekawa
authors.forename: Toshio
authors.initials: T
authors.lastname: Ogihara
authors.forename: Kenshi
authors.initials: K
authors.lastname: Fujii
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation*; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization; D003326:Coronary Circulation; D004617:Embolism / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D011446:Prospective Studies; D018616:Ultrasonography, Doppler, Duplex; D018084:Ultrasonography, Interventional