Distal embolization during primary angioplasty: Histopathologic features and predictability

Limbruno, Ugo; Carlo, Marco De; Pistolesi, Sabina; Micheli, Andrea De; Petronio, Anna Sonia; Camacci, Tiziano; Fontanini, Gabriella; Balbarini, Alberto; Mariani, Mario; Caterina, Raffaele De

doi:10.1016/j.ahj.2005.01.016

Cited by 105 publications

(61 citation statements)

References 26 publications

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“…diabetic patients undergoing primary PCI. These findings strengthen the argument for the crucial role of platelet reactivity and the thrombus burden in the pathogenesis of no-reflow [12]. …”

supporting

confidence: 56%

Aspirin ‘Resistance', Diabetes Mellitus and No-Reflow: The Elusive Role of Individual Susceptibility in Myocardial Reperfusion

Scalone¹,

Niccoli²

2015

Cardiology

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supporting

confidence: 56%

Aspirin ‘Resistance', Diabetes Mellitus and No-Reflow: The Elusive Role of Individual Susceptibility in Myocardial Reperfusion

Scalone¹,

Niccoli²

2015

Cardiology

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“…In the same setting, other researchers have also shown that abciximab does not affect the total number and the mean total volume of embolized material or its qualitative composition. 30 This perhaps suggests that a similar mechanism of distal embolization, possibly consisting of plaque debris rather than thrombotic material, may occur in both elective and primary PCI for acute myocardial infarction.…”

Section: Clinical Impactmentioning

confidence: 99%

Plaque Volume and Occurrence and Location of Periprocedural Myocardial Necrosis After Percutaneous Coronary Intervention

et al. 2006

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Background-Myocardial necrosis can occur during percutaneous coronary intervention (PCI) despite optimal adjunctive pharmacology and careful technique. We investigated the mechanisms of procedural infarction using angiographic analysis, intravascular ultrasound, and delayed-enhancement magnetic resonance imaging. Methods and Results-Fifty-two patients (64 vessels) who underwent complex PCI were studied. All patients were preloaded with clopidogrel and received glycoprotein IIb/IIIa inhibitors. "Adjacent" myonecrosis was defined as the presence of an area of new gadolinium hyperenhancement close to the stent. "Distal" myonecrosis was defined as situated at least 10 mm downstream from the stent. Fifteen vessels (23%) had evidence of new hyperenhancement after PCI. Of these, 8 (12%) had the distal type, and 7 (11%) had the adjacent type. Intravascular ultrasound showed a significantly greater reduction in plaque volume (91.6Ϯ51.5 versus 8Ϯ14 versus 20Ϯ35 mm

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Recent observations indicate that periprocedural MIs are associated with increased atherosclerotic burden and large LCPs. [15][16][17][18][19][20][21][22][23][24][25][26] Embolization of the lipid core of stenotic plaques after PCI has been implicated as an important cause of periprocedural no-reflow and MI in both the presence and absence of intracoronary thrombus. [23][24][25][26] The efficacy of embolic protection devices (EPDs) in preventing embolic complications after PCI of saphenous vein grafts and carotid arteries suggests that embolic periprocedural MIs occurring during dilations of stenoses in native coronary arteries may be prevented if LCPs prone to periprocedural MI could be accurately identified.…”

mentioning

confidence: 99%

Detection of Lipid-Core Plaques by Intracoronary Near-Infrared Spectroscopy Identifies High Risk of Periprocedural Myocardial Infarction

Goldstein

Maini

Dixon

et al. 2011

Circ: Cardiovascular Interventions

198

136

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Background-Percutaneous coronary intervention (PCI) is associated with periprocedural myocardial infarction (MI) in3% to 15% of cases (depending on the definition used). In many cases, these MIs result from distal embolization of lipid-core plaque (LCP) constituents. Prospective identification of LCP with catheter-based near-infrared spectroscopy (NIRS) may predict an increased risk of periprocedural MI and facilitate development of preventive measures. Methods and Results-The present study analyzed the relationship between the presence of a large LCP (detected by NIRS) and periprocedural MI. Patients with stable preprocedural cardiac biomarkers undergoing stenting were identified from the COLOR Registry, an ongoing prospective observational study of patients undergoing NIRS before PCI. The extent of LCP in the treatment zone was calculated as the maximal lipid-core burden index (LCBI) measured by NIRS for each of the 4-mm longitudinal segments in the treatment zone. A periprocedural MI was defined as new cardiac biomarker elevation above 3ϫ upper limit of normal. A total of 62 patients undergoing stenting met eligibility criteria. A large LCP (defined as a maxLCBI 4 mm Ն500) was present in 14 of 62 lesions (22.6%), and periprocedural MI was documented in 9 of 62 (14.5%) of cases. Periprocedural MI occurred in 7 of 14 patients (50%) with a maxLCBI 4 mm Ն500, compared with 2 of 48 patients (4.2%) patients with a lower maxLCBI 4 mm (Pϭ0.0002). Conclusions-NIRS

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Distal embolization during primary angioplasty: Histopathologic features and predictability

Cited by 105 publications

References 26 publications

Aspirin ‘Resistance', Diabetes Mellitus and No-Reflow: The Elusive Role of Individual Susceptibility in Myocardial Reperfusion

Aspirin ‘Resistance', Diabetes Mellitus and No-Reflow: The Elusive Role of Individual Susceptibility in Myocardial Reperfusion

Plaque Volume and Occurrence and Location of Periprocedural Myocardial Necrosis After Percutaneous Coronary Intervention

Detection of Lipid-Core Plaques by Intracoronary Near-Infrared Spectroscopy Identifies High Risk of Periprocedural Myocardial Infarction

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