Distal Protection Improved Reperfusion and Reduced Left Ventricular Dysfunction in Patients With Acute Myocardial Infarction Who Had Angioscopically Defined Ruptured Plaque

Abstract

Background-Distal protection, in the Saphenous Vein Graft Angioplasty Free of Emboli (SAFER) trial, is demonstratedto prevent distal embolism in the percutaneous coronary intervention of saphenous vein graft. However, in the Enhanced Myocardial Efficacy and Recovery by Aspiration of Liberated Debris (EMERALD) trial, it was not effective in the percutaneous coronary intervention of native coronary arteries in patients with acute myocardial infarction (AMI). We hypothesized that its effectiveness would be determined by lesion characteristics. Therefore, we classified the type of culprit lesion by angioscopy and examined its influence on the effectiveness of distal protection, comparing patients with AMI treated with and without distal protection. Methods and Results-Consecutive patients with AMI treated without distal protection (nϭ110) who had angioscopically defined ruptured plaque. Distal embolization of plaque debris was detected more frequently in patients with ruptured plaque. These results suggest that microcirculation damage and left ventricular dysfunction are increased mainly by distal embolization of plaque debris rather than of thrombus.

Intense Yellow Culprit Plaque Coloration is Closely Associated with Troponin-T Elevation and Flow Complications Following Elective Coronary Stenting

“…Ruptured plaque has been reported to be related to distal embolization by stenting 19) ; therefore, this finding corresponded with our results. However, plaque complexity was not significantly higher in multivariate analysis than intense yellow plaque because the intense yellow plaque did not necessarily correspond with either plaque complexity or thrombus.…”

“…Although ruptured yellow plaques and intracoronary massive thrombi in the culprit plaques of acute coronary syndrome were frequently observed in a previous study 21) , there were no massive thrombi in this study because all patients had stable angina pectoris and only mural thrombi. A previous study suggested plaque debris to more strongly influence both the slow-flow phenomenon and distal embolization after stenting than thrombi 19) . As a result, mural thrombi are not considered to likely be either a powerful predictor or to have the ability to induce post-procedural myocardial injury in cases of In this study, the frequency of pre-dilatation, maximum pressure inflation and the total inflation time were not found to influence post-procedural myocardial injury, while the total stent length was associated with post-procedural myocardial injury.…”

Coronary microvascular reperfusion injury and no-reflow in acute myocardial infarction

“…Directional and rotational atherectomy has a higher risk of no-reflow than balloon angioplasty. 26 Thrombolytic drugs can activate the complement and kinin systems, and increase the concentration of IL-6 and thrombin. Endothelium damage results in collagen exposure.…”

Effect of a distal protection device on epicardial blood flow and myocardial perfusion in primary percutaneous coronary intervention

“…Using glycoprotein IIb/IIIa receptor blockade might have reduced the chances of additional improvement through distal protection in the EMERALD trial. Mizote et al(2005) revealed that distal protection reduced microcirculation damage and left ventricular dysfunction in patients with AMI who had ruptured plaque. Yoon et al(2006) also found that distal protection may effectively preserve the microvascular integrity of the myocardium during primary PCI in AMI patients.…”