Distal Embolization during Native Vessel and Vein Graft Coronary Intervention with a Vascular Protection Device: Predictors of High‐Risk Lesions

Abstract

Longer stent length, likely reflecting increased lesion length and plaque burden, predicted significant distal embolism during PCI in native vessel and vein graft lesions, as assessed by debris collected in a distal vascular protection device. This suggests that use of vascular protection devices should be considered during PCI of long lesions.

Aspirate from human stented native coronary arteries vs. saphenous vein grafts: more endothelin but less particulate debris

“…The ex vivo measurement of calcium, endothelin, serotonin, TxB 2 , tissue factor, and TNF␣ in particulate debris confirmed the comparable plaque composition by IVUS VH. Despite of the comparable plaque volume and composition, we found less particulate debris in coronary aspirate from nRCA than from SVG-RCA, again confirming prior studies (9,12). Apparently, when compared with native coronary arteries, the thinner medial layer of the SVGs predisposes them to mechanical damage during interventional plaque rupture and to release of more particulate debris (35).…”

“…Upon stent implantation, native vessels release less and smaller particulate debris than SVGs (9,12). However, the histological composition of the released particulate debris from native vessels and SVGs during elective and acute interventions does not differ (12).…”

Coronary Microembolization

“…8,[13][14][15][16][17][18][19] Particle size appeared larger in patients with unstable rather than stable angina 20 and with increasing patient age. 21 Embolic material retrieved from the particularly microembolization-susceptible saphenous vein bypass grafts contains more bioactive atherosclerotic material (necrotic core, foam cells, cholesterol) than that from native vessels (extracellular matrix, smooth muscle cells) 17 ; also, more debris is retrieved from saphenous vein bypass grafts than from native vessels undergoing PCI.…”

“…8,[13][14][15][16][17][18][19] Particle size appeared larger in patients with unstable rather than stable angina 20 and with increasing patient age. 21 Embolic material retrieved from the particularly microembolization-susceptible saphenous vein…”

“…Periprocedural coronary microembolization occurs on average in 25% of all PCIs, but its incidence ranges from 0% to 70%, in part depending on the method of its assessment. 7 The incidence of periprocedural coronary microembolization depends on factors related to the clinical condition of the patient, notably preexisting kidney disease or underlying unstable angina; factors related to the length 8 or complexity of the lesion; and finally, factors related to the procedure, notably the use of a stent rather than percutaneous transluminal coronary angioplasty, the number and duration of inflations, and particularly the use of atherectomy and rotablation. 7 In patients with an acute myocardial infarction, an angiographic distal filling defect occurred as evidence of coronary microembolization in 7% to 16% of patients and was related to thrombus burden, increased myocardial damage, and reduced effectiveness of reperfusion.…”