Effects of a Distal Protection Device During Primary Stenting in Patients With Acute Anterior Myocardial Infarction

Abstract

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....

<b>Percutaneous Coronary Arterial Thrombectomy for Acute Myocardial Infarction Reduces No-Reflow Phenomenon and Protects Against Left Ventricular Remodeling Related to the Proximal Left Anterior Descending and Right Coronary Artery</b>

“…Nakamura, et al suggested that a strategy of thrombectomy therapy alone before stent implantation cannot prevent embolism related to these materials and that PCI with a distal protection device should be considered to be the only prevention therapy for noreflow phenomenon by distal embolism. 18) However, the Enhanced Myocardial Efficacy and Recovery by Aspiration of Liberated Debris (EMERALD) trial suggested that distal embolic protection did not result in improved microvascular flow, greater reperfusion success, reduced infarct size, or enhanced event-free survival, 29) and the results of the Protection Devices in PCI Treatment of Myocardial Infarction for Salvage of Endangered Myocardium (PROMISE) study revealed no benefit of distal protection. 30) The results of the Randomized Evaluation of the Effect of Mechanical Reduction of Distal Embolization by ThrombusAspiration in Primary and Rescue Angioplasty (REMEDIA) trial and other studies indicate that reperfusion is improved after thrombectomy, but whether these results can be transformed into small infarcts or better outcomes has not yet been determined.…”

Comparison of the Effects of a Distal Embolic Protection Device and an Aspiration Catheter During Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction

“…Nakamura et al reported the benefit of distal protection during PCI for AMI patients. 25 Their subjects were any AMI patients within 24 h of the onset of AMI without any exclusion of lesion morphology. Further study is necessary to identify cases suitable for distal protection.…”

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

“…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].…”