Coronary microembolization: from bedside to bench and back to bedside.
Coronary microembolization from the erosion or rupture of a vulnerable atherosclerotic plaque occurs spontaneously in acute coronary syndromes and iatrogenically during percutaneous coronary interventions. Typical consequences of coronary microembolization are microinfarcts with an inflammatory response, contractile dysfunction, and reduced coronary reserve. Apart from transient elevations of creatine kinase and troponin, microemboli can be visualized by intracoronary Doppler and the resulting microinfarcts by late-enhancement nuclear magnetic resonance. Statins, antiplatelet agents, and coronary vasodilators protect against microembolization and microinfarction when started before percutaneous coronary interventions. Distal protection devices can retrieve atherothrombotic debris and prevent its embolization into the microcirculation, but their effect on clinical outcome has been disappointing so far, except for saphenous vein bypass grafts. Devices for aspiration of thrombi and thrombus-derived vasoconstrictor, thrombogenic, and inflammatory substances, however, reduce thrombus burden, improve perfusion, and provide protection in patients with acute myocardial infarction.
Heusch
Gerd
G
Institut für Pathophysiologie, Universitätsklinikum Essen, Essen, Germany. gerd.heusch@uk-essen.de
Kleinbongard
Petra
P
Böse
Dirk
D
Levkau
Bodo
B
Haude
Michael
M
Schulz
Rainer
R
Erbel
Raimund
R
D000818:Animals; D015415:Biomarkers; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003326:Coronary Circulation; D003952:Diagnostic Imaging; D004617:Embolism / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D004864:Equipment and Supplies; D006401:Hematologic Agents / Q000627:therapeutic use; D006801:Humans; D008833:Microcirculation; D009200:Myocardial Contraction
D015415:Biomarkers; D002317:Cardiovascular Agents; D006401:Hematologic Agents