Spontaneous and Procedural Plaque Embolisation in Native Coronary Arteries: Pathophysiology, Diagnosis, and Prevention

Maria, Giovanni Luigi De; Patel, Niket; Kassimis, George; Banning, Adrian P.

doi:10.1155/2013/364247

Cited by 12 publications

(12 citation statements)

References 137 publications

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“…This condition is well known as no reflow and is mainly related to a profound impairment of coronary microvasculature secondary to ischaemia/reperfusion injury and distal embolisation 28. The advocated mechanisms of action of PICSO make it a very attractive device for application in limiting and eventually minimising the impact of no reflow.…”

Section: Clinical Setting For Potential Successful Applications Of Csimentioning

confidence: 99%

Reconsidering the back door approach by targeting the coronary sinus in ischaemic heart disease

Maria

Kassimis

Raina

et al. 2016

Heart

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Coronary sinus interventions (CSI) are a class of invasive techniques (surgical and percutaneous) originally proposed in the first half of the 20th century, aiming to treat ischaemic heart disease by acting on the venous coronary system. Three main classes of CSI have been proposed and tested: (1) retroperfusion technique, (2) retroinfusion technique and (3) coronary sinus occlusion techniques. They all share the principle that a controlled increased pressure within the coronary sinus may promote a retrograde perfusion of the ischaemic myocardium with consequent cardioprotection. Development of arterial treatments including coronary aortic bypass grafting and then percutaneous coronary intervention deflected interest from interventions on the coronary venous system. However, CSI may still have a possible niche role today in specific and selected clinical contexts in which existing therapies are insufficient. In this review paper, we aim to revise the rationale for CSI, describing the details and the evidence collected so far about these techniques and to provide insights about the main clinical scenarios in which these strategies may find a contemporary application in combination or as an alternative to existing approaches.

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Section: Clinical Setting For Potential Successful Applications Of Csimentioning

confidence: 99%

Reconsidering the back door approach by targeting the coronary sinus in ischaemic heart disease

Maria

Kassimis

Raina

et al. 2016

Heart

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“…Furthermore, coronary microemboli is considered to be inevitable during PCI revascularization of obstructive atherosclerotic plaque [62], because plaques and debris are disrupted during the passage of guide-wires, positioning of the balloon and stent implant. Differentiation of spontaneous from procedural microembolization is difficult because patients arrive to the hospital with pre-existing AMI related to coronary thrombi and PCI revascularization is also associated with microthrombi.…”

Section: Coronary Microembolimentioning

confidence: 99%

“…Galiuto classified microvascular damage after revascularization into structural (irreversible) and functional (reversible), where the structural damage is related to damage of microvascular walls; conversely, the functional damage is related to edema and cellular plugging [101]. De Maria et al showed the similarity in the sequelae of spontaneous and procedural distal microembolization [62]. Jaffe et al described two pattens of MVO, namely zonal MVO located in the core of pre-existing infart (primery PCI) and patchy MVO located in ischemic myocardium (elective PCI) [44].…”

Section: Microvascular Obstruction and Microinfarctionmentioning

confidence: 99%

Monitoring the Sequelae of Coronary Microembolization on Myocardium Using Noninvasive Imaging (Review)

Saeed¹,

Wilson²

2014

WJCD

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Acute myocardial infarction (AMI) is a leading cause of death worldwide. It has been clinically classified into 1) ischemic from a primary coronary event (e.g., plaque rupture or thrombotic occlusion), 2) ischemic from a supply-and-demand mismatch and c) ischemic from a percutaneous coronary interventions (PCI). Catheter-based PCI has been frequently used as an alternative to conventional bypass surgery for patients at high risk. However, this method of treatment is associated with microvascular obstruction (MVO) by dislodged microemboli that results in left ventricular (LV) dysfunction/remodeling, perfusion deficits, microinfarction and arrhythmia. The contributions of microemboli after revascularization of AMI have been acknowledged by major cardiac and interventional societies. Recent studies showed that Emboli Detection and Classification (EDAC) Quantifier offers increased sensitivity and capability for detecting dislodged coronary microemboli during PCI. Coronary microembolization can be detected directly by monitoring intramyocardial contrast opacification on contrast echocardiography, increasing F-18 fluorodeoxyglucose (FDG) uptake on positron emission tomography, loss/diminution of signal on first pass perfusion and hypoenhanced zone on contrast enhanced magnetic resonance imaging (MRI) and multidetector computed tomography (MDCT) and indirectly by ST-segment elevation on electrocardiography (ECG). The relations between volumes/sizes of microemboli, visibility of microinfarct, myocardial perfusion and LV function are still under intensive discussions. Non-invasive imaging can play important role in assessing these parameters. This review shed the light on the techniques used for detecting coronary microemboli, microvascular obstruction and microinfarct and the short-and long-term effects of microemboli on LV function, structure and perfusion.

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“…Although the management of coronary artery disease (CAD) has developed and improved dramatically during the past two decades, CAD is still a disease with increasing morbidity and mortality posing a major threat to human's health [1,2]. e pathogenesis of CAD includes several mechanisms [3], such as lipid metabolism [4,5], inflammatory response [6,7], and activation of the coagulation and fibrinolysis system [8]. Alanine aminotransferase (ALT) is referred as liver transaminase and predominantly expressed by hepatocytes.…”

Section: Introductionmentioning

confidence: 99%

ALT-to-Lymphocyte Ratio as a Predictor of Long-Term Mortality in Patients with Normal Liver Function Presenting Coronary Artery Disease after Undergoing PCI: A Retrospective Cohort Study

Zheng

Guo

Tang

et al. 2020

Journal of Interventional Cardiology

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Background. Alanine aminotransferase (ALT) is referred as liver transaminase and predominantly expressed by hepatocytes. Previous evidences showed that high levels of ALT were reversely associated with short- and long-term outcomes in patients with myocardial infarction. Besides, low lymphocyte has been demonstrated to be significantly correlated with adverse clinical outcomes in coronary artery disease (CAD). However, evidences about the relationship between ALT-to-lymphocyte ratio (ALR) and outcomes in CAD patients with normal liver function are limited. The aim of this study was to assess the relationship between ALR and clinical outcomes in patients with CAD. Methods. This is a retrospective cohort study, and a total of 3561 patients were enrolled in Clinical Outcomes and Risk Factors of Patients with CAD after percutaneous coronary intervention (PCI), from January 2013 to December 2017. After excluding patients with liver dysfunction, we finally enrolled 2714 patients. These patients were divided into two groups according to ALR value: the lower group (ALR < 14.06, n = 1804) and the higher group (ALR ≥ 14.06, n = 910). The average follow-up time was 37.59 ± 22.24 months. Results. We found that there were significant differences between the two groups in the incidence of all-cause mortality (ACM) (P<0.001) and cardiac mortality (CM) (P=0.010). Kaplan–Meier survival analysis suggested that CAD patients with higher ALR tended to have an increased accumulated risk of ACM and CM (log rank P<0.001 and P=0.006, respectively). Multivariate Cox regression analysis showed that ALR was an independent predictor of ACM (hazard ratio (HR) = 2.017 (95% confidence interval (CI): 1.289–3.158), P=0.002) and CM (HR = 1.862 (95% CI: 1.047–3.313), P=0.034). We did not find significant difference in the incidence of major adverse cardiovascular events (MACEs) and major adverse cardiovascular and cerebrovascular events (MACCEs) between the two groups after adjustments of confounders. Conclusion. Our results indicate that ALR is an independent predictor of long-term adverse outcomes in CAD patients who underwent PCI.

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Spontaneous and Procedural Plaque Embolisation in Native Coronary Arteries: Pathophysiology, Diagnosis, and Prevention

Cited by 12 publications

References 137 publications

Reconsidering the back door approach by targeting the coronary sinus in ischaemic heart disease

Reconsidering the back door approach by targeting the coronary sinus in ischaemic heart disease

Monitoring the Sequelae of Coronary Microembolization on Myocardium Using Noninvasive Imaging (Review)

ALT-to-Lymphocyte Ratio as a Predictor of Long-Term Mortality in Patients with Normal Liver Function Presenting Coronary Artery Disease after Undergoing PCI: A Retrospective Cohort Study

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