A fresh look at coronary microembolization

Kleinbongard, Petra; Heusch, Gerd

doi:10.1038/s41569-021-00632-2

Cited by 87 publications

(67 citation statements)

References 236 publications

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“…Coronary microembolization occurs spontaneously or iatrogenically during PCI when atherothrombotic particulate debris and soluble vasoconstrictor, thrombogenic and inflammatory substances are released from erosion or rupture of an atherosclerotic plaque [ 117 ]. Spontaneous coronary microembolization may be clinically silent and become only apparent by chance in elevated serum troponin concentrations.…”

Section: Heart Failure Of Ischemic Originmentioning

confidence: 99%

“…Spontaneous coronary microembolization may be clinically silent and become only apparent by chance in elevated serum troponin concentrations. Direct evidence for coronary microembolization is achieved only when it occurs clinically as an acute coronary syndrome or during PCI [ 117 ]. Repetitive, also repetitive clinically silent coronary microembolization may ultimately result in diffuse ischemic cardiomyopathy [ 117 ].…”

Section: Heart Failure Of Ischemic Originmentioning

confidence: 99%

“…Direct evidence for coronary microembolization is achieved only when it occurs clinically as an acute coronary syndrome or during PCI [ 117 ]. Repetitive, also repetitive clinically silent coronary microembolization may ultimately result in diffuse ischemic cardiomyopathy [ 117 ].…”

Section: Heart Failure Of Ischemic Originmentioning

confidence: 99%

“…Patients with a cancer history have more coronary ischemic events [ 234 ] and a higher incidence of myocardial infarction [ 153 ] than those without. They also have a higher incidence of plaque erosion which is, in turn, associated with coronary microembolization, [ 117 ] and they have worse clinical outcome [ 234 ]. Cancer therapy not only induces toxic or inflammatory injury to cardiomyocytes [ 83 , 241 ] but also to the vasculature, including the coronary vasculature [ 82 , 178 , 271 ].…”

Section: Heart Failure Of Ischemic and Non-ischemic Originmentioning

confidence: 99%

“…For irreversible ischemia and myocardial infarction, prevention of coronary microvascular obstruction is of pivotal importance. Unfortunately, interventional approaches using protection devices to attenuate coronary microvascular obstruction are of limited value and recommended only in cases of large atherothrombotic burden on angiography [ 117 ]. Also, pharmacological approaches to attenuate coronary microvascular obstruction, i.e., by use of adenosine, nitroprusside or calcium antagonists have been of limited clinical value [ 92 , 96 ].…”

Section: Conclusion and Directions For Future Researchmentioning

confidence: 99%

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Coronary blood flow in heart failure: cause, consequence and bystander

Heusch

2022

Basic Res Cardiol

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Heart failure is a clinical syndrome where cardiac output is not sufficient to sustain adequate perfusion and normal bodily functions, initially during exercise and in more severe forms also at rest. The two most frequent forms are heart failure of ischemic origin and of non-ischemic origin. In heart failure of ischemic origin, reduced coronary blood flow is causal to cardiac contractile dysfunction, and this is true for stunned and hibernating myocardium, coronary microembolization, myocardial infarction and post-infarct remodeling, possibly also for the takotsubo syndrome. The most frequent form of non-ischemic heart failure is dilated cardiomyopathy, caused by genetic mutations, myocarditis, toxic agents or sustained tachyarrhythmias, where alterations in coronary blood flow result from and contribute to cardiac contractile dysfunction. Hypertrophic cardiomyopathy is caused by genetic mutations but can also result from increased pressure and volume overload (hypertension, valve disease). Heart failure with preserved ejection fraction is characterized by pronounced coronary microvascular dysfunction, the causal contribution of which is however not clear. The present review characterizes the alterations of coronary blood flow which are causes or consequences of heart failure in its different manifestations. Apart from any potentially accompanying coronary atherosclerosis, all heart failure entities share common features of impaired coronary blood flow, but to a different extent: enhanced extravascular compression, impaired nitric oxide-mediated, endothelium-dependent vasodilation and enhanced vasoconstriction to mediators of neurohumoral activation. Impaired coronary blood flow contributes to the progression of heart failure and is thus a valid target for established and novel treatment regimens.

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Section: Heart Failure Of Ischemic Originmentioning

confidence: 99%

Section: Heart Failure Of Ischemic Originmentioning

confidence: 99%

Section: Heart Failure Of Ischemic Originmentioning

confidence: 99%

Section: Heart Failure Of Ischemic and Non-ischemic Originmentioning

confidence: 99%

Section: Conclusion and Directions For Future Researchmentioning

confidence: 99%

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Coronary blood flow in heart failure: cause, consequence and bystander

Heusch

2022

Basic Res Cardiol

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Biocompatible Liquid Embolic for the Treatment of Microvascular Hemorrhage

Keum,

Kim,

Zhang

et al. 2024

Advanced Science

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Persistent or recurrent bleeding from microvessels inaccessible for direct endovascular intervention is a major problem in medicine today. Here, an innovative catheter‐directed liquid embolic (P‐LE) is bioengineered for rapid microvessel embolization to treat small vessel hemorrhage. Tested in rodent, porcine, and canine animal models under normal and coagulopathic conditions, P‐LE outperformed clinically used embolic materials in both survival and non‐survival experiments, effectively occluding vessels as small as 40 microns with no signs of recanalization. P‐LE occlusion is independent of the coagulation cascade, and its resistance to displacement is ≈ 8 times greater than systolic blood pressure. P‐LE is also found to be biocompatible and x‐ray visible and does not require polymerization or a chemical reaction to embolize. To simulate the clinical scenario, acute microvascular hemorrhage is created in the pig kidney, liver, or stomach; these are successfully treated with P‐LE achieving immediate hemostasis. Furthermore, P‐LE is found to be bactericidal to highly resistant patient‐derived bacteria, suggesting that P‐LE may also protect against infectious complications that may occur following embolization procedures. P‐LE is safe, easy to use, and effective in treating ‐microvessel hemorrhage.

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Efficacy of catheter‐based drug delivery in a hybrid in vitro model of cardiac microvascular obstruction with porcine microthrombi

Rösch,

Stolte,

Weisskopf

et al. 2023

Bioengineering & Transla Med

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Microvascular obstruction (MVO) often occurs in ST‐elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention (PCI). Diagnosis and treatment of MVO lack appropriate and established procedures. This study focused on two major points by using an in vitro multiscale flow model, which comprised an aortic root model with physiological blood flow and a microfluidic model of the microcirculation with vessel diameters down to 50 μm. First, the influence of porcine microthrombi (MT), injected into the fluidic microchip, on perfusion was investigated. We found that only of all injected MT were fully occlusive. Second, it could also be shown that the maximal concentration of a dye (representing therapeutic agent) during intracoronary infusion could be increased on average by , when proximally occluding the coronary artery by a balloon during drug infusion. The obtained results and insights enhance the understanding of perfusion in MVO‐affected microcirculation and could lead to improved treatment methods for MVO patients.

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A fresh look at coronary microembolization

Cited by 87 publications

References 236 publications

Coronary blood flow in heart failure: cause, consequence and bystander

Coronary blood flow in heart failure: cause, consequence and bystander

Biocompatible Liquid Embolic for the Treatment of Microvascular Hemorrhage

Efficacy of catheter‐based drug delivery in a hybrid in vitro model of cardiac microvascular obstruction with porcine microthrombi

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