Perioperative myocardial infarction caused by atheroembolism

Thrombus predicts ischemic complications during percutaneous coronary intervention in saphenous vein grafts: Results from TARGET (do tirofiban and reopro give similar efficacy trial?)

“…Percutaneous coronary intervention (PCI) of saphenous vein bypass graft (SVG) lesions carries an increased risk of distal embolization and myocardial infarction (MI) compared with PCI of native vessels [1, 2]. These ischemic complications are associated with an increased risk of in‐laboratory adverse angiographic events [3] and adverse clinical events [4, 5].…”

Severe systemic cholesterol embolization after open heart surgery

“…2. In a series of 4095 CABG, Keon, Heggtveit and Leduc [30] reported nine deaths (0.22 %) related to atheromatous embolization into the coronary microcirculation. Moreover, among 175 patients who were re-operated on after a first CABG, four patients (2.29 %) died from intraoperative massive myocardial infarction after atheroembolization of the distal coronary circulation.…”

Myocardial Protection in Reoperative Coronary Artery Bypass Grafting:. Toward Decreasing Morbidity and Mortality

“…First, old SVG atheromatous disease may embolize into the coronary circulation. Keon and colleagues 13 performed an autopsy series and reported a 2.3% incidence of fatal myocardial infarction caused by distal embolization of atheromatous material from old SVG. Second, myocardial distribution of antegrade cardioplegia is unpredictable in redo CABG patients.…”

“…The morbidity and mortality of redo CABG are significantly higher than first‐time CABG, but continue to gradually decrease 1–7 . The major hurdles to the completion of an uncomplicated redo CABG operation are fourfold: (i) increased risk of massive hemorrhage during redo sternotomy, 8–10 (ii) injury to patent grafts, 11,12 (iii) embolization of atheromatous debris caused by manipulation of diseased bypass grafts, 13 and (iv) inadequate cardioplegia delivery 14 . The increased atherosclerotic burden also increases the likelihood of systemic atheroembolization and increased risk of associated complications such as cerebrovascular accidents.…”