arly restoration of blood flow in the infarct-related artery (IRA) with consequent restitution of myocardial perfusion is the aim of treatment of patients with acute myocardial infarction (AMI). [1][2][3][4][5] A strategy of routine stent implantation during percutaneous coronary intervention (PCI) in AMI patients is the most immediate and reliable method for recanalizing the occluded artery, but the limitations of this strategy include distal embolism and a lower incidence of thrombolysis in myocardial infarction (TIMI) study grade 3 flow, compared with primary angioplasty alone. 6,7 The no-reflow phenomenon, which is characterized by impaired myocardial perfusion despite reopening of the epicardial coronary artery, can occur during PCI in patients with AMI and is predictive of poor prognosis. [8][9][10] This phenomenon, when identified on an angiogram, is named 'angiographic no-reflow' and is defined as coronary antegrade flow reduction without mechanical obstruction: it occurs in 10-20% of patients with AMI despite reopening of the IRA by PCI. 6,7,9,11 EmCirculation Journal Vol.68, August 2004 bolization of thrombus and plaque may play an important role in angiographic no-reflow. 12,13 Although thrombectomy before mechanical dilatation provides better angiographic epicardial coronary flow in AMI, it is still unclear whether this strategy could provide better myocardial perfusion. 14 A recent study demonstrated that the occlusive balloon type distal protection device (PercuSurge GuardWire; GW) reduced distal embolization during scheduled PCI for venous grafts, 15 but little is known about the effects of this device against no-reflow during emergency PCI in AMI patients. It is also unclear whether left ventricular (LV) function is preserved by PCI with GW protection. We hypothesized that primary stenting with GW protection could reduce angiographic no-reflow and preserve LV function. Methods Patient PopulationSeventy-two consecutive patients with their first anterior AMI who were treated with primary stenting from January 1, 2001 to July 31, 2003 were enrolled. Criteria for study inclusion were (1) first anterior AMI, (2) within 24 h of onset, and (3) a proximal lesion of the left anterior descending artery (LAD). The diagnosis of AMI was defined as (1) continuous chest pain lasting >30 min, (2) ST elevation >1.0 mm in 2 or more contiguous precordial ECG leads, and (3) >3-fold increase in serum creatine kinase (CK) above the normal value. Exclusion criteria were (1) patients Background The angiographic no-reflow phenomenon is an adverse prognostic factor in patients with acute myocardial infarction (AMI). The aim of the present study was to evaluate the effects of an occlusive balloon type distal protection device (PercuSurge GuardWire: GW) during primary stenting in patients with anterior AMI. Methods and ResultsThe GW group included 42 patients treated by primary stenting with GW protection and the control group included 30 patients treated by primary stenting after thrombectomy without distal protection....

Figure. (A) Axial fluid-attenuated inversion recovery imaging. (B) Collapse imaging of brain MR angiography (MRA) showing stenosis of the left P2 segment (arrow). (C) Collapse imaging of previous brain MRA.