Current status of distal embolization in percutaneous coronary intervention: mechanical and pharmacological strategies.
Distal embolization during percutaneous coronary intervention for acute myocardial infarction or saphenous vein graft disease may result in microvascular obstruction and the 'no-reflow' phenomenon. The incidence of distal embolization ranges from 2 to 42% in saphenous vein graft intervention and from 6 to 15% in primary percutaneous coronary intervention and is associated with impaired myocardial perfusion and poor outcome. Several mechanical and pharmacological strategies have been proposed to prevent or to treat embolization in percutaneous coronary intervention and have been tested in clinical trials. The pivotal role of distal embolization in the pathophysiology of microvascular obstruction will lead to the further development of preventive and therapeutic strategies. Strategies to counteract distal embolization and future directions are discussed in this review.
Haeck
Joost De
JD
Department of Cardiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands. j.d.haeck@amc.uva.nl
Verouden
Niels J W
NJ
Henriques
José P S
JP
Koch
Karel T
KT
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D000925:Anticoagulants / Q000627:therapeutic use; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D004617:Embolism / Q000209:etiology* / Q000517:prevention & control*; D006083:Graft Occlusion, Vascular / Q000628:therapy; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012501:Saphenous Vein / Q000637:transplantation; D017131:Thrombectomy / Q000295:instrumentation
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors