Distal protection in native coronary arteries during primary angioplasty in acute myocardial infarction: Single‐center experience

Multicentre experience with MGuard™ net protective stent in ST‐elevation myocardial infarction: Safety, feasibility, and impact on myocardial reperfusion

“…EPD, such as proximal or distal occlusion devices or filters, have been widely used in several studies: although histological studies have shown that filters contain debris of thrombotic material in virtually all cases, [28] to date, their use did not improve clinical outcome improvement [29,30]. Furthermore, considering published and unpublished trials regarding EPD use in STEMI patients, it could be evident that trials reported variable results ranging from 63 [28] to 88% [31] for MBG 3, from 84 [32] to 95% [33] for final TIMI 3 antegrade coronary flow, with complete (>70%) STr ranging from 68 [31] to 83% [34]. Mechanical thrombus removal systems did not achieve univocal results [35,36].…”

Feasibility of primary clot extraction prior to percutaneous coronary intervention in acute myocardial infarction

“…Various strategies or techniques such as multiple balloon inflations followed by stenting, primary stenting, intra- coronary thrombolytics or glycoprotein 2b3a inhibitor administration, angiojet, or Express catheter suction devices have been used in cases of acute MI with clot [1,[10][11][12][13]. None of these techniques is ideal as challenges such as subacute and organized clot formation, incomplete or partially successful results, distal embolization, no-reflow, and infarct extension can still occur [6]. Additionally, some of these techniques, especially those with bulky devices, can cause injury to coronary artery segments remote from the site of stenosis or plaque rupture leading to the use of additional stents to cover the injured segments with the potential of higher complication rates of acute and subacute thrombosis or restenosis.…”

“…The results of the use of distal protection devices such as balloon occlusion and aspiration devices or distal filters in native coronary arteries during acute MI have been variable. Some studies showed improvement in LV function and in markers of myocardial reperfusion [6,10] whereas other studies showed no significant improvement in reperfusion success, microvascular flow, infarct size reduction, LV function, or event-free survival [6,10,13,24]. The FilterWire EZ device was used as a clot extractor in acute native coronary artery occlusions in two case reports.…”

“…PCI is a very effective method for re-establishing coronary perfusion and is superior to thrombolytics if done timely in STEMI and is also beneficial in non-STEMI [4,5]. Distal embolization with resultant noreflow or slow flow during PCI in the setting of acute MI can occur in up to 10-25% of patients with lack of an effective technique to prevent its occurrence resulting in poorer recovery of left ventricular (LV) function and a higher rate of post-MI complications [6][7][8]. Large thrombus burden is an independent predictor of major adverse cardiac events and infarct-related artery stent thrombosis in patients treated with drug eluting stents for STEMI [9].…”

Caught up, then pushed down: the tribulations of one underexpanded coronary stent

“…Observation studies suggest the beneficial impact of using distal protection devices and encourage their use in patients with thrombus-containing coronary lesions and other embolic-prone stenosis, such as degenerated saphenous vein aortocoronary bypass grafts [1][2][3][4][5]. However, following the example of a lucky fisherman, an invasive cardiologist should be aware that a stent could be imprisoned in the "net", even when the final angiographic result looks fine.…”