Detection and quantification of embolic particles during percutaneous coronary intervention to stable plaque: It correlates to coronary flow dynamics and myocardial damage

Okamura, Atsunori; Ito, Hiroshi; Iwakura, Katsuomi; Kawano, Shigeo; Kurotobi, Toshiya; Date, Motoo; Inoue, Koichi; Ogihara, Toshio; Fujii, Kenshi

doi:10.1002/ccd.20971

Cited by 14 publications

(17 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[4][5][6][7] Distal embolization is one of the strongest contributors to PMI, and embolic particles are frequently observed during PCI. 1,8,9) The amount of microembolization is strongly related to the magnitude of cTn elevation, microvascular dysfunction, and worsening of cardiac function. [8][9][10] Myocardial microvascular function can be evaluated by quantifying the coronary flow reserve (CFR).…”

mentioning

confidence: 99%

“…1,8,9) The amount of microembolization is strongly related to the magnitude of cTn elevation, microvascular dysfunction, and worsening of cardiac function. [8][9][10] Myocardial microvascular function can be evaluated by quantifying the coronary flow reserve (CFR). 11) A pressure/ temperature sensor-tipped guidewire can measure fractional flow reserve (FFR) and CFR by thermodilution.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Impact of Coronary Plaque Burden and Composition on Periprocedural Myocardial Infarction and Coronary Flow Reserve After Percutaneous Coronary Intervention

et al. 2014

View full text Add to dashboard Cite

SummaryPeriprocedural myocardial infarction (PMI) is one of the major complications of percutaneous coronary intervention (PCI). We investigated the influence of coronary plaque burden and characteristics on PMI using intravascular ultrasound (IVUS) with radiofrequency-based tissue characterization technology (iMAP). The study population consisted of 33 consecutive patients with stable angina pectoris who underwent PCI. IVUS images were recorded before and after PCI for offline analysis, and coronary flow reserve (CFR) was measured after PCI. PMI was defined as a post-PCI cardiac troponin T elevation > 5 × 99 th percentile of the upper reference limit (0.014 ng/mL). Plaque volume in patients with PMI (n = 12) was significantly greater than that in patients without PMI (n = 21) (240.4 ± 106.0 mm 3 versus 152.1 ± 76.9 mm 3 , P = 0.0096). The iMAP-IVUS analysis demonstrated that the fibrotic, lipidic, and necrotic tissue volume within culprit lesions were also greater in patients with PMI than in patients without PMI (129.4 ± 52.2 mm 3 versus 94.6 ± 40.8 mm , P = 0.0071, respectively). Multivariate logistic analysis demonstrated that necrotic tissue volume was the only independent predictor of PMI. Multiple regression analysis demonstrated that the post-PCI CFR values significantly correlated with percent plaque burden, and there were no correlations with the percent tissue burden of each plaque component. In conclusion, the iMAP-IVUS analyses demonstrate that necrotic tissue volume is a potent predictor of PMI. Microcirculatory disturbance after PCI is significantly influenced by percent plaque burden, regardless of plaque compositions. (Int Heart J 2014; 55: 391-396)

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

Impact of Coronary Plaque Burden and Composition on Periprocedural Myocardial Infarction and Coronary Flow Reserve After Percutaneous Coronary Intervention

et al. 2014

View full text Add to dashboard Cite

show abstract

“…In previous PCI studies, it was shown that the coronary microembolism is frequently induced directly after balloon deflation and especially after stent implantation. 3,4,23,24 Distal protection systems during transcatheter treatment of aorto-coronary saphenous vein graft stenosis, confirmed the process of coronary microembolization 30 whereas thrombotic and nonthrombotic material with a size from 100 to 550 lm was identified. 6 Microemboli consisting of such thrombotic and non-thrombotic material cause high intensity signals (HITS) within the Doppler velocity spectrum.…”

Section: Introductionmentioning

confidence: 80%

Automatic Detection of Microemboli During Percutaneous Coronary Interventions

et al. 2007

View full text Add to dashboard Cite

The objective of this study was to develop an analysis method for the automatic detection of intracoronary microemboli triggered high intensity signals (HITS) during percutaneous coronary interventions (PCI). The recorded ultrasonic Doppler velocity spectra from an intracoronary ultrasonic guide-wire were decomposed into 13 wavelet scales applying the continuous wavelet transform. From 7 wavelet scales which were most suitable for a differentiation between HITS and pulsatile flow, envelopes were calculated and combined to improve the HITS-to-background noise ratio. For different intensity thresholds the resulting number of HITS was automatically counted and compared with the number estimated by experienced observers. In a first validation trial HITS were detected within a simplified in vitro model with a sensitivity of 89.2% and a positive predictive value of 87.6%. In a following clinical study 211 HITS from 18 patients during PCI were counted manually by the observers. With the developed wavelet-based method 189 HITS were correctly detected (sensitivity of 89.6%, positive predictive value of 85.5%). The introduced new method automatically detects intracoronary HITS for the first time with a reliable accuracy. This may support further studies evaluating the incidence and consequences of coronary microembolization during coronary interventions.

show abstract

“…10 -12 Microemboli, detected with an intracoronary Doppler guidewire in 27 of 31 patients undergoing PCI, were significantly more common in those with troponin elevation. 10 Although some patients have emboli large enough to occlude a branch vessel large enough to be seen at angiography, the vast majority of emboli are quite small, as are the ischemic territories. 29 Pretreatment with several agents has been shown to decrease biomarker release after PCI in small randomized trials.…”

Section: Discussionmentioning

confidence: 99%

The sPLA ₂ Inhibition to Decrease Enzyme Release After Percutaneous Coronary Intervention (SPIDER-PCI) Trial

Džavík

Lavi²,

Thorpe³

et al. 2010

Circulation

View full text Add to dashboard Cite

Background— Secretory phospholipase A 2 (sPLA 2 ) may play a role in myonecrosis after elective percutaneous coronary intervention (PCI). Inhibition of this enzyme may have a beneficial effect. The central hypothesis of this study was that treatment with varespladib, a small-molecule inhibitor of sPLA 2 would reduce postprocedural release of cardiac biomarkers after elective percutaneous coronary intervention. Methods and Results— Between October 2007 and June 2009, 144 stable patients were randomized in a phase II trial to receive varespladib 500 mg PO BID or placebo 3 to 5 days before and for 5 days after elective percutaneous coronary intervention. The primary end point was elevation of troponin I or creatine kinase-MB above the upper limit of normal at 6 to 8 or 18 to 24 hours after percutaneous coronary intervention. Mean age was 63±10 and 64±10 years, with 38% and 42% with diabetes mellitus and 29% and 28% with prior myocardial infarction for the varespladib and placebo groups, respectively. The primary end point occurred in 75% of varespladib and 63% of placebo patients ( P =0.14). Troponin I 3 times the upper limit of normal was observed in 57% and 50% ( P =0.39) and creatine kinase-MB 2 times the upper limit of normal in 14% and 3% ( P =0.018). Median (first and third quartiles) change in high-sensitivity C-reactive protein in these 2 groups was 0.65 mg/L (−0.18 and 1.48) and 0.70 mg/L (0.00 and 1.50) at 18 to 24 hours ( P =0.81) and 0.20 mg/L (−0.70 and 1.40) and 0.60 mg/L (−0.12 and 1.72) at 3 to 5 days ( P =0.23), whereas change in sPLA 2 activity at 3 to 5 days in a subset was −2.85 ng/ml (−3.40 and −1.85) and 0.25 ng/ml (−0.20 and 0.85) ( P <0.001). Conclusions— Inhibition of sPLA 2 by varespladib administered for 3 to 5 days before the procedure does not reduce periprocedural myonecrosis associated with elective percutaneous coronary intervention. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00533039.

show abstract

Detection and quantification of embolic particles during percutaneous coronary intervention to stable plaque: It correlates to coronary flow dynamics and myocardial damage

Abstract: Embolic particles are frequently observed during PCI to stable plaque and the majority are liberated after stenting. There appears to be a quantitative relationship between amounts of HITS and coronary microvessel dysfunction and minor myocardial injury.

Cited by 14 publications

References 49 publications

Impact of Coronary Plaque Burden and Composition on Periprocedural Myocardial Infarction and Coronary Flow Reserve After Percutaneous Coronary Intervention

Impact of Coronary Plaque Burden and Composition on Periprocedural Myocardial Infarction and Coronary Flow Reserve After Percutaneous Coronary Intervention

Automatic Detection of Microemboli During Percutaneous Coronary Interventions

The sPLA ₂ Inhibition to Decrease Enzyme Release After Percutaneous Coronary Intervention (SPIDER-PCI) Trial

Contact Info

Product

Resources

About

Detection and quantification of embolic particles during percutaneous coronary intervention to stable plaque: It correlates to coronary flow dynamics and myocardial damage

Abstract: Embolic particles are frequently observed during PCI to stable plaque and the majority are liberated after stenting. There appears to be a quantitative relationship between amounts of HITS and coronary microvessel dysfunction and minor myocardial injury.

Cited by 14 publications

References 49 publications

Impact of Coronary Plaque Burden and Composition on Periprocedural Myocardial Infarction and Coronary Flow Reserve After Percutaneous Coronary Intervention

Impact of Coronary Plaque Burden and Composition on Periprocedural Myocardial Infarction and Coronary Flow Reserve After Percutaneous Coronary Intervention

Automatic Detection of Microemboli During Percutaneous Coronary Interventions

The sPLA 2 Inhibition to Decrease Enzyme Release After Percutaneous Coronary Intervention (SPIDER-PCI) Trial

Contact Info

Product

Resources

About

The sPLA ₂ Inhibition to Decrease Enzyme Release After Percutaneous Coronary Intervention (SPIDER-PCI) Trial