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

Background Cilostazol and ticlopidine are commonly prescribed for prevention of thrombosis after coronary stenting, but few studies have compared them. Methods and ResultsIn the present study 642 patients who underwent stenting were randomized to treatment either with cilostazol + aspirin (C group, 321 patients) or ticlopidine + aspirin (T group, 321 patients). Quantitative coronary angiography (QCA) was performed immediately after stenting and at the 6-month follow-up. Treatment was continued until follow-up angiography. Baseline patient characteristics did not differ significantly. With the exception of a higher rate of stenting in a venous graft in the C group, there were no differences in angiographic characteristics or stent type. Baseline QCA analysis of the reference diameter, minimal lumen diameter (MLD) showed no significant differences. Follow-up QCA analysis of the MLD showed no significant differences. There were also no differences in restenosis or target lesion revascularization rates, or in the incidence of adverse reactions. However, the rate of subacute thrombosis (SAT) was significantly higher in the C group than in the T group (2% vs 0.3%, p=0.02). Conclusion In the present study there was a similar restenosis rate with cilostazol or ticlopidine, but the rate of SAT was significantly higher with cilostazol. There was no significant difference in adverse reactions. (Circ J 2005; 69: 780 -785)

Section: Discussioncontrasting

confidence: 62%

Randomized Comparison of Cilostazol vs Ticlopidine for Antiplatelet Therapy After Coronary Stenting

Takeyasu

Watanabe

Noguchi

et al. 2005

“…16 Recently, Taguchi et al also reported that using a distal protection device is superior to the aspiration method for distal embolization after PCI with stenting for AMI. 17 In our study, the post-PCI TMP grades were more favorable in group A than in B. TMP grade 3 was more common in group A, and in 49 selected patients with TIMI grade 3 flow, TMP grade 3 was also more common in group A. These results suggest that a distal protection device is effective in the recovery of reperfusion at the myocardial tissue level, which may be effective in preserving the microvascular integrity of the myocardium during primary PCI.…”

Section: Discussionmentioning

confidence: 99%

“…It has been suggested that a distal embolization protection device may be a safe and effective tool in preserving the microvasculature of the myocardium during primary PCI in AMI. [14][15][16][17][18] The coronary angiographic Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion grade (TMP) 19,20 and phasic coronary flow velocity patterns, as assessed by an intracoronary Doppler wire after primary PCI, both of which represent the myocardial reperfusion status and microvascular integrity of the IRA, are related to functional improvement of the left ventricle and prognosis of the patient. 21,22 Thus, the aim of the present study was to determine the effectiveness of the PercuSurge GuardWire ® system in preserving the microvascular integrity of the myocardium during primary PCI in AMI patients, using the intracoronary Doppler wire to measure coronary flow velocities and phasic coronary flow velocity patterns of the IRA following primary PCI.…”

mentioning

confidence: 99%

Effect of Distal Protection Device on the Microvascular Integrity in Acute Myocardial Infarction During Primary Percutaneous Coronary Intervention

Yoon

Tahk

Choi

et al. 2006

cute myocardial infarction (AMI) is commonly related with thrombotic occlusion following a plaque rupture. Accordingly, early relief of the occluded coronary artery and restoration of the coronary flow to the jeopardized myocardium have been demonstrated to decrease mortality and adverse outcomes. 1,2 Primary percutaneous coronary intervention (PCI), with stent deployment in AMI, has been reported as more effective than balloon angioplasty, from the viewpoint of decreasing the rate of target vessel revascularization and restenosis. [3][4][5] However, as distal embolization of ruptured atherosclerotic plaque debris or thrombus is common during primary PCI with catheter-based interventions, stent deployment may also endow a greater chance of distal embolization than balloon angioplasty. 5 Evidence has accumulated that an obstruction of the distal microvasculature in the downstream bed of the infarct-related artery (IRA) is caused by distal embolization of thrombotic materials and platelets during intervention. [6][7][8] These are critical pathophysiologic events of myocardial infarction (MI), which is subsequently related to the slowflow or no-reflow phenomenon and associated with additional injury to the microvasculature of the myocardium and poor clinical outcomes. 9-13 Therefore, restoration of the epicardial coronary artery will not always guarantee reperfusion of the microvasculature of the myocardium and reperfusion at the myocardial tissue level by preserving the microvasculature is crucial, as is opening of the epicardial coronary artery during primary PCI. It has been suggested that a distal embolization protection device may be a safe and effective tool in preserving the microvasculature of the myocardium during primary PCI in AMI. [14][15][16][17][18] The coronary angiographic Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion grade (TMP) 19,20 and phasic coronary flow velocity patterns, as assessed by an intracoronary Doppler wire after primary PCI, both of which represent the myocardial reperfusion status and microvascular integrity of the IRA, are related to functional improvement of the left ventricle and prognosis of the patient. 21,22 Thus, the aim of the present study was to determine the effectiveness of the PercuSurge GuardWire ® system in preserving the microvascular integrity of the myocardium during primary PCI in AMI patients, using the intracoronary Doppler wire to measure coronary flow velocities and phasic coronary flow velocity patterns of the IRA following primary PCI. Methods Patient PopulationA total of 58 consecutive patients (mean age: 54±15 years; 46 males, 12 females) with first episode of ST-segment-elevated AMI, who had undergone primary PCI and a coronary Doppler flow study within 24 h of symptom onset, were enrolled. The diagnosis of AMI was based on characteristic chest pain persisting for more than 30 min, significant ST segment elevation (>1 mm in limb lead and >2 mm in precordial lead) in ≥2 contiguous ECG leads, and an

“…Recently, distal protection devices have been reported to be effective in preventing reperfusion injury and no-reflow phenomenon. 27,28 However, in the Enhanced Myocardial Efficacy and Recovery by Aspiration of Liberated Debris (EMERALD) trial, distal embolic protection did not result in improved microvascular flow, greater reperfusion success, reduced infarct size, or enhanced event-free survival. 29 Since the relative CT number and coronary microcirculatory variables were significantly correlated with the infract size in the present study, the broad intramyocardial hemorrhage and/ or expansion of the left ventricular lumen itself might impair the coronary microvascular reflow just after epicardial coronary revascularization in acute MI.…”

Section: Discussionmentioning

confidence: 99%

Plain Computed Tomography for Assessment of Early Coronary Microcirculatory Damage After Revascularization Therapy in Acute Myocardial Infarction

Kato

Dote

Sasaki

et al. 2006

yocardial salvage after reperfusion may be limited by deleterious changes in the microcirculation of the previously ischemic tissue, 1 which can result in a progressive decrease of capillary blood flow to potentially viable myocytes (no-reflow phenomenon) in acute myocardial infarction (MI). 2 Previous studies using an intracoronary Doppler guidewire demonstrated that the coronary flow velocity pattern measured immediately after successful revascularization is predictive of the recovery of regional and global left ventricular function in patients with acute MI. 3,4 Furthermore, myocardial contrast echocardiography can independently detect microcirculatory damage and myocardial viability early after acute MI. [5][6][7] Recently, computed tomography (CT) has been used to evaluate the myocardial perfusion in stable angina or acute coronary syndrome. 8,9 A previous experimental study in a canine model demonstrated that both progression of the contrast defect area in myocardial contrast echocardiography with a gradual thickening of the wall and an enhancement of myocardial area detected by CT just after reperfusion are charCirculation Journal Vol. 70, November 2006 acteristic of hemorrhagic infarction. 10,11 The aim of the present study was to clarify the relationship between the microcirculatory impairment and prolonged enhancement of reperfused myocardium after successful revascularization in acute MI. Methods Patient Population and Study DesignThirteen consecutive patients (11 men, 2 women), aged from 45 to 79 years (mean age: 67±12 years), who suffered their first acute anterior MI were enrolled in the study. The diagnosis of acute MI was made on the basis of chest pain lasting for over 30 min, ST elevation of at least 2 mm in 2 adjacent leads on the electrocardiogram, and an increase of serum creatine kinase (CK) to more than twice the normal upper limit. Each patient had complete occlusion or severe stenotic lesion of the proximal or middle segment of the left anterior descending artery (LAD) on emergency coronary angiography, and underwent successful percutaneous coronary intervention (PCI) within 6 h after the onset of symptoms. The coronary blood flow velocity pattern and coronary flow velocity reserve in the LAD were measured immediately after PCI using a Doppler guidewire in 13 patients. All patients underwent chest CT immediately after successful revascularization. The left ventricular ejection fraction (LVEF) and left ventricular end-diastolic volume (LVEDV) Background Coronary microcirculatory damage is an important factor for the prognosis for acute myocardial infarction (MI) after revascularization. The myocardial enhancement area with contrast media infused during coronary revascularization therapy, detected by computed tomography (CT) just after revascularization, has been reported to correspond to the area of hemorrhagic infarction. The relationship between myocardial contrast enhancement and coronary microcirculatory damage was investigated in the present study. Methods and ResultsThirteen pati...