Distal Protection During Primary Coronary Intervention Can Preserve the Index of Microcirculatory Resistance in Patients With Acute Anterior ST-Segment Elevation Myocardial Infarction

Ito, Noritoshi; Nanto, Shinsuke; Doi, Yasuji; Kurozumi, Yuma; Tonomura, Daisuke; Natsukawa, Tomoaki; Sawano, Hirotaka; Masuda, Daisuke; Yamashita, Shizuya; Okada, Kenichiro; Hayashi, Yasuyuki; Tsuiki, Kai; Hayashi, Takuma

doi:10.1253/circj.cj-10-0133

Cited by 17 publications

(13 citation statements)

References 37 publications

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“…In this regard, the use of a mechanical device for thrombus removal or trapping to improve clinical outcomes after p-PCI is attractive, and the efficacy of these devices has been tested in many clinical trials. Although some data, especially those regarding the use of distal protection devices, have failed to show clinical benefits due in part to patient and device selection [48][49][50][51][52][53] , many recent large-scale randomized trials have demonstrated significant improvements in myocardial perfusion 45,[54][55][56][57][58][59][60][61][62][63][64][65][66][67] and the left ventricular function 64,65) in addition to reduced mortality 68) ( 69) . In addition, Burzotta et 70) .…”

Section: Thrombus Aspiration/distal Protection Therapy and Its Efficacymentioning

confidence: 99%

Thrombus Aspiration Therapy and Coronary Thrombus Components in Patients with Acute ST-Elevation Myocardial Infarction

Yunoki

Naruko

Sugioka

et al. 2013

JAT

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Inflammation and oxidative stress play key roles in atherosclerotic plaque instability, and plaque rupture/erosion and subsequent thrombus formation constitute the principal mechanisms of total vessel occlusion and acute ST-elevation myocardial infarction (STEMI). Plaque disruption triggers the formation of initial platelet aggregates that grow in association with an increase in fibrin formation, leading to persistent coronary flow obstruction and blood coagulation. The fibrin network may trap large numbers of erythrocytes and inflammatory cells to form an erythrocyte-rich thrombus. In fact, previous clinical studies have shown that not only platelet-rich white thrombi, but also erythrocyte-rich red thrombi can be visualized using angioscopy in patients with acute coronary syndrome. Recently, the development of thrombus aspiration and distal protection devices has significantly improved the clinical outcomes of percutaneous intervention in STEMI patients and has enabled the evaluation of antemortem coronary artery thrombi. This is important because previous autopsy studies were unable to differentiate coronary thrombi responsible for myocardial ischemia from postmortem clots. Using frozen samples of aspirated thrombi and specific monoclonal antibodies, we investigated the cellular components of thrombi (platelets, erythrocytes, fibrin and inflammatory cells, such as myeloperoxidase-positive cells) and pathologically evaluated the relationships between erythrocyterich thrombi and inflammation, oxidative stress and clinical outcomes in STEMI patients. Therefore, this review article focuses on the efficacy of thrombus aspiration therapy and the components of aspirated intracoronary thrombi in STEMI patients and presents the results of recent studies regarding the relationship between the composition of aspirated intracoronary thrombi and clinical outcomes.

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Section: Thrombus Aspiration/distal Protection Therapy and Its Efficacymentioning

confidence: 99%

Thrombus Aspiration Therapy and Coronary Thrombus Components in Patients with Acute ST-Elevation Myocardial Infarction

Yunoki

Naruko

Sugioka

et al. 2013

JAT

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“…Moreover, another report demonstrated that distal protection during PCI effectively retrieved the embolic debris and preserved the index of microcirculatory resistance in patients with an acute anterior STEMI [14]. Embolic protection devices are designed to be able to retrieve atherothrombotic debris and prevent its distal embolisation, but their effect on clinical outcomes has not been established, except for saphenous vein bypass grafts [6,7,[15][16][17].…”

Section: Discussionmentioning

confidence: 99%

In vitro assessment of six aspiration catheters using a distal protection filter

Fujimura

Okamura

Ando³

et al. 2016

Cardiol J.

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Results: Among the 6 catheters evaluated, the use of the Export Advance catheter (Medtronic) resulted in significantly shorter lengths of the suspended embolus matter compared to the use of the TVAC II (Nipro), Thrombuster III SL (Kaneka), and Rebirth Pro (Goodman) catheters (p < 0.01). The residual embolus matter in all cases had drained distally to the distal protection filter when the filter was retrieved. Conclusions:The use of the Export Advance catheter showed better performance using a distal protection filter in this in vitro experiment, and its use might be more effective in preventing distal embolisms in combination with a distal protection filter. (Cardiol J 2016; 23, 6: 667-672)

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“…In patients undergoing coronary stenting for stable angina and ST-elevation MI (STEMI), stent placement was found to cause microvascular injury as evaluated by IMR. [20][21][22] Previous data from Melikian, et al suggest that there is large overlap in IMR values between patients with or without epicardial atherosclerosis. Impact of smoking on coronary physiology: The finding that among patients with CAD, smokers had greater IMR than nonsmokers, suggests that smoking adversely affects coronary microcirculatory resistance.…”

Section: Discussionmentioning

confidence: 99%

Impact of Smoking on Coronary Microcirculatory Resistance in Patients With Coronary Artery Disease

et al. 2015

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SummaryThe aim of this study was to investigate the relationship between coronary microvascular function and smoking using the 3 parameters fractional flow reserve (FFR), coronary flow reserve (CFR thermo ), and index of microcirculatory resistance (IMR) in patients with coronary artery disease (CAD). A total of 97 CAD patients with 148 intermediate stenotic lesions were divided into two groups: current and former smokers (Smokers: n = 54), and those who had never smoked (Non-smokers: n = 43). Coronary physiology measurements were made following coronary angiography at rest and during hyperemia induced with intravenous adenosine triphosphate. If a patient had several intermediate lesions, the lesion producing the largest IMR value and minimum FFR myo and CFR thermo value was selected. Averaged over all patients, the FFR myo , CFR thermo , and IMR values were 0.86 ± 0.10, 2.66 ± 1.50, and 20.8 ± 10.7, respectively. There was no significant correlation between FFR myo and IMR. There were no significant differences between smokers and non-smokers in FFR myo value ( perfusion is dependent on both epicardial and microvascular resistance. 1) An increased microcirculatory resistance indicates the presence of coronary microvascular dysfunction (CMVD), a term introduced to describe abnormalities in the regulation of microvascular blood flow. CMVD has been found to play an important role in determining ischemic threshold 2) and to be independent of epicardial stenosis severity.3) Smoking is known to be associated with the development of epicardial atherosclerosis and impairment of coronary endothelial function. [4][5][6] However, the effects of smoking on coronary microvascular function are unknown.Recently, a parameter called the index of microcirculatory resistance (IMR) was proposed for evaluating coronary microvascular function. The advantage of this parameter is that it could be calculated from values obtained using a coronary temperature and pressure sensing guidewire. 7) IMR has been found to be a reproducible index and to be independent of epicardial stenosis severity.7-10) The aim of this study was to investigate the relationship between microvascular function and smoking in patients with CAD by comparing 3 coronary physiology parameters, fractional flow reserve (FFR), coronary flow reserve (CFR), and IMR, between patients with and without a smoking history. MethodsStudy population: A total of 97 patients with CAD who had 148 discrete intermediate grade stenotic lesions (40-70% diameter stenosis on visual assessment) and visited the Department of Cardiovascular Medicine, Kashiwa Municipal Hospital (Chiba, Japan) from August 2010 to August 2013 were retrospectively enrolled. To examine the relationship between coronary physiology and smoking, patients were divided into two groups based on smoking status; current and former smokers (smokers), and those who had never smoked (non-smokers). The exclusion criteria were 1) history of coronary artery bypass surgery; 2) history of myocardial infarction (MI); 3) recent MI,...

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Distal Protection During Primary Coronary Intervention Can Preserve the Index of Microcirculatory Resistance in Patients With Acute Anterior ST-Segment Elevation Myocardial Infarction

Cited by 17 publications

References 37 publications

Thrombus Aspiration Therapy and Coronary Thrombus Components in Patients with Acute ST-Elevation Myocardial Infarction

Thrombus Aspiration Therapy and Coronary Thrombus Components in Patients with Acute ST-Elevation Myocardial Infarction

In vitro assessment of six aspiration catheters using a distal protection filter

Impact of Smoking on Coronary Microcirculatory Resistance in Patients With Coronary Artery Disease

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