Distal Embolic Protection in Patients With Acute Myocardial Infarction

Randomized Comparison of Distal Protection Versus Conventional Treatment in Primary Percutaneous Coronary Intervention

“…In addition, infarct size determined by 99m Tc-sestamibi single-photon emission computerized tomography, the coprimary end point of the study, tended to be larger in the patient group assigned to distal protection. Embolization of thrombus material during manipulation of the device in the infarctrelated area is an inherent risk of the mechanical interventions that has to be taken into account when the lack of efficacy of both the EMERALD and the present studies are interpreted (23). In addition, the Boston Scientific filterwire requires a landing zone of the device at least 30 mm distal to the segment that is going to be stented.…”

Adjunctive Thrombectomy for Acute Myocardial Infarction

“…4,5 Meta-analyses of adjunctive thrombectomy trials have reported a definite improvement in surrogate markers of reperfusion. 6 -8 These trials tested a variety of devices that either aspirate (Diver CE, Proto, Export, TVAC, and Rescue; Table 1) or fragment (AngioJet and X-sizer; Table 1) the coronary thrombus.…”

Effects of distal protection on left ventricular function in acute anterior myocardial infarction: a Doppler echocardiographic study

“…Recently, the Randomized Evaluation of the Effect of Mechanical Reduction of Distal Embolization by ThrombusAspiration in Primary and Rescue Angioplasty (REMEDIA) trial showed better angiographic and electrocardiographic myocardial perfusion rates in the myocardial protection arm compared with those achieved by standard PCI [7]. Along with the promising results with DPDs, some inconclusive and conflicting data in AMI interventions have been the subject of controversy [9][10][11]. The large randomized Enhanced Myocardial Efficacy and Recovery by Aspiration of Liberated Debris (EMERALD) trial showed that DPDs allowed effective retrieval of embolic debris in most patients with AMI undergoing emergent PCI.…”

“…Early studies of DPDs in AMI patients reported improvements in myocardial perfusion and ST-segment resolution compared with conventional PCI techniques [2,3,[6][7][8]. Some subsequent studies yielded neutral results [9][10][11]. Whether myocardial function can be improved with DPDs compared with conventional PCI in patients with AMI is still under debate [3,[7][8][9].…”