Myonecrosis following stent placement: Association between impaired TIMI myocardial perfusion grade and MRI visualization of microinfarction

Choi, James W.; Gibson, C. Michael; Murphy, Sabina A.; Davidson, Charles J.; Kim, Raymond J.; Ricciardi, Mark J.

doi:10.1002/ccd.20024

Cited by 44 publications

(29 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Recently, MRI visualization of microinfarction has been linked with impaired TMPG in 14 patients. 3 Our evaluation of the TMPG confirms these previous results but is further validated by consistency with 2 other techniques (CMR and IVUS) and extends these results to a larger sample undergoing elective PCI.…”

Section: Discussionsupporting

confidence: 86%

“…2,3 Despite a variety of techniques to minimize compromise of side branches during stenting, 4 smaller vessels cannot always be protected, and some compromise of flow down branch vessels may be inevitable when long coronary stents are placed over areas of extensive atheroma. 5 Downstream embolization of material from the atheromatous plaque during stent implantation may be ubiquitous, 6 but the clinical relevance of embolization in native coronary arteries has been debated, particularly since the disappointing results from studies using distal protection devices in the setting of acute myocardial infarction.…”

Section: Editorial P 620 Clinical Perspective P 669mentioning

confidence: 99%

See 1 more Smart Citation

Plaque Volume and Occurrence and Location of Periprocedural Myocardial Necrosis After Percutaneous Coronary Intervention

et al. 2006

View full text Add to dashboard Cite

Background-Myocardial necrosis can occur during percutaneous coronary intervention (PCI) despite optimal adjunctive pharmacology and careful technique. We investigated the mechanisms of procedural infarction using angiographic analysis, intravascular ultrasound, and delayed-enhancement magnetic resonance imaging. Methods and Results-Fifty-two patients (64 vessels) who underwent complex PCI were studied. All patients were preloaded with clopidogrel and received glycoprotein IIb/IIIa inhibitors. "Adjacent" myonecrosis was defined as the presence of an area of new gadolinium hyperenhancement close to the stent. "Distal" myonecrosis was defined as situated at least 10 mm downstream from the stent. Fifteen vessels (23%) had evidence of new hyperenhancement after PCI. Of these, 8 (12%) had the distal type, and 7 (11%) had the adjacent type. Intravascular ultrasound showed a significantly greater reduction in plaque volume (91.6Ϯ51.5 versus 8Ϯ14 versus 20Ϯ35 mm

show abstract

Section: Discussionsupporting

confidence: 86%

Section: Editorial P 620 Clinical Perspective P 669mentioning

confidence: 99%

Plaque Volume and Occurrence and Location of Periprocedural Myocardial Necrosis After Percutaneous Coronary Intervention

et al. 2006

View full text Add to dashboard Cite

show abstract

“…We and others have recently demonstrated that areas of new myonecrosis visualized with DE-MRI are linked to impaired TIMI perfusion grade on angiographic analysis immediately after the procedure. 14,25 In the present study, we have extended this by finding that areas of myocardium injured during PCI exhibit reduced myocardial perfusion for at least 24 hours after the interventional procedure.…”

Section: Discussionmentioning

confidence: 53%

Effect of Distal Embolization on Myocardial Perfusion Reserve After Percutaneous Coronary Intervention

et al. 2007

View full text Add to dashboard Cite

Background-Studies have shown that a subset of patients demonstrate persistent impairment in microcirculatory function after percutaneous coronary intervention (PCI). Distal embolization of plaque contents has been postulated as the main mechanism for this. We sought to investigate this further by evaluating PCI-induced changes in myocardial perfusion reserve index (MPRI) over time in segments with "distal-type" procedure-related myonecrosis using high-resolution quantitative cardiovascular magnetic resonance imaging. Methods and Results-Forty patients undergoing PCI were studied with pre-PCI and 24-hour post-PCI delayedenhancement magnetic resonance imaging and first-pass perfusion magnetic resonance imaging at rest and stress. Twenty patients underwent a third magnetic resonance imaging scan at 6 months. For perfusion imaging, 3 short-axis images were acquired during every heartbeat with a T1-weighted turboFLASH sequence. Pϭ0.50). At 6 months after the procedure, mean MPRI in segments with new injury improved significantly compared with MPRI measured in these segments at 24 hours after PCI. Conclusions-MPRI is reduced in myocardial segments that demonstrate new distal irreversible injury at 24 hours after PCI. These reductions are confined to the segments with injury and do not affect the entire supply territory of the culprit vessel.

show abstract

“…In addition, coronary stenting may also cause microvascular obstruction due to embolization. 19 Another well recognized cause of periprocedural MI is the compromise of large sidebranches …”

Section: Periprocedural MI and Sidebranch Occlusion With Coronary Stentsmentioning

confidence: 99%

Frequency and Clinical Consequences Associated With Sidebranch Occlusion During Stent Implantation Using Zotarolimus-Eluting and Paclitaxel-Eluting Coronary Stents

Popma

Mauri

O’Shaughnessy

et al. 2009

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

Background-Myocardial infarction (MI) after drug-eluting stent placement has been associated with an unfavorable late prognosis. Although the etiology of periprocedural MI is multifactorial, sidebranch occlusion may be an important contributing factor. We sought to identify the incidence of sidebranch occlusion during zotarolimus-eluting stent (ZES) and paclitaxel-eluting stent (PES) placement and to relate sidebranch occlusion to the occurrence of periprocedural MI. Methods and Results-Angiograms were reviewed from patients randomly assigned to treatment with a ZES (597 patients; 943 sidebranches) or a PES (619 patients; 977 sidebranches). Sidebranch occlusion was defined as Thrombolysis in Myocardial Infarction flow grade 0 or 1. Sidebranch occlusion was correlated with frequency of MI, as assessed by the creatine phosphokinase MB isoenzyme. Sidebranch occlusion occurred less often after the first stent deployment in patients treated with ZES (2.2%) than in patients treated with PES (4.0%; Pϭ0.032). A similar reduction in the frequency of sidebranch occlusion at any point during the procedure was found in patients treated with ZES (2.9% versus 4.8% in PES patients; Pϭ0.042). Multivariable predictors of sidebranch occlusion included baseline sidebranch stenosis, complex lesion morphology, smaller baseline minimal lumen diameters, and the use of a PES.Of the 20 patients with MI within 30 days of the procedure, 30% had evidence of sidebranch occlusion during the stent procedure. Conclusions-Patients

show abstract

Myonecrosis following stent placement: Association between impaired TIMI myocardial perfusion grade and MRI visualization of microinfarction

Cited by 44 publications

References 28 publications

Plaque Volume and Occurrence and Location of Periprocedural Myocardial Necrosis After Percutaneous Coronary Intervention

Plaque Volume and Occurrence and Location of Periprocedural Myocardial Necrosis After Percutaneous Coronary Intervention

Effect of Distal Embolization on Myocardial Perfusion Reserve After Percutaneous Coronary Intervention

Frequency and Clinical Consequences Associated With Sidebranch Occlusion During Stent Implantation Using Zotarolimus-Eluting and Paclitaxel-Eluting Coronary Stents

Contact Info

Product

Resources

About