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

Kelbæk, Henning; Terkelsen, Christian Juhl; Helqvist, Steffen; Lassen, Jens Flensted; Clemmensen, Peter; Kløvgaard, Lene; Kaltoft, Anne; Engstrøm, Thomas; Bøtker, Hans Erik; Saunamäki, Kari; Krusell, Lars Romer; Jørgensen, Erik; Hansen, Henrik Lyngbeck; Christiansen, Evald Høj; Ravkilde, Jan; Køber, Lars; Kofoed, Klaus F.; Thuesen, Leif

doi:10.1016/j.jacc.2007.10.047

Cited by 138 publications

(79 citation statements)

References 35 publications

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“…Thus, although, distal EPDs showed favorable clinical benefits during PCI in saphenous vein grafts, the results in PPCI setting for native vessel were not so good. Resuming, no differences were reported on ST-segment resolution, infarct size and MACE rates with distal EPDs compared to standard PPCI [84][85][86] . These data were confirmed by the meta-analysis by Kunadian et al [87] , where the use of distal EPDs resulted in no decrease of early mortality or recurrent myocardial infarction rate.…”

Section: Embolic Protection Devicesmentioning

confidence: 94%

“…The DEDICATION trial, evaluating patients randomized to distal protection using a filter wire (FilterWire-EZ), or a SpiderFX protection device, vs standard PPCI without distal protection, showed no significant difference in the primary endpoint of ST-segment resolution or in cardiac biomarker elevation or left ventricular wall motion index, and found a higher MACCE rate with distal protection [85] . Thus, although, distal EPDs showed favorable clinical benefits during PCI in saphenous vein grafts, the results in PPCI setting for native vessel were not so good.…”

Section: Embolic Protection Devicesmentioning

confidence: 99%

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Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

Vecchio¹

2014

WJC

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Acute ST-elevation myocardial infarction (STEMI) usually results from coronary atherosclerotic plaque disruption with superimposed thrombus formation. Detection of coronary thrombi is a poor prognostic indicator, which is mostly proportional to their size and composition. Particularly, intracoronary thrombi impair both epicardial blood flow and myocardial perfusion, by occluding major coronary arteries and causing distal embolization, respectively. Thus, although primary percutaneous coronary intervention is the preferred treatement strategy in STEMI setting, the associated use of adjunctive antithrombotic drugs and/or percutaneous thrombectomy is crucial to optimize therapy of STEMI patients, by improving either angiographical and clinical outcomes. This review article will focus on the prognostic significance of intracoronary thrombi and on current antithrombotic pharmacological and interventional strategies used in the setting of STEMI to manage thrombotic lesions.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: ST-elevation myocardial infarction; Intracoronary thrombosis; Primary percutaneous coronary intervention; Antithrombotic therapies; Coronary thrombectomyCore tip: Intracoronary thrombosis, is the basic pathophysiologic event in acute ST-elevation myocardial infarction (STEMI), and thrombi are very frequently detected in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Thrombus burden and components are important determinants of prognosis in STEMI, being well-known risk factors for longterm adverse cardiovascular events, distal embolization and stent thrombosis. As a result, percutaneous management of lesions with a consistent thrombotic burden is still challenging in the setting of PPCI for STEMI. Therefore, several pharmacological and interventional strategies, such as thrombectomy have been developed in order to improve PPCI's safety and efficacy, by reducing thrombus burden.

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Section: Embolic Protection Devicesmentioning

confidence: 94%

Section: Embolic Protection Devicesmentioning

confidence: 99%

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

Vecchio¹

2014

WJC

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“…In clinical practice, despite the use of a distal protection device and an aspiration device, same cases showed severe final TIMI flow grade 0 or 1 for STEMI [11]. Several recent clinical trials demonstrated that the routine therapy of intracoronary aspiration thrombectomy and distal protection during primary PCI for acute MI has not improved clinical outcomes despite the removal of debris, except in cases with a high risk of distal embolization [11,12].…”

Section: Discussionmentioning

confidence: 99%

In vitro assessment of six aspiration catheters using a distal protection filter

Fujimura

Okamura

Ando³

et al. 2016

Cardiol J.

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Results: Among the 6 catheters evaluated, the use of the Export Advance catheter (Medtronic) resulted in significantly shorter lengths of the suspended embolus matter compared to the use of the TVAC II (Nipro), Thrombuster III SL (Kaneka), and Rebirth Pro (Goodman) catheters (p < 0.01). The residual embolus matter in all cases had drained distally to the distal protection filter when the filter was retrieved. Conclusions:The use of the Export Advance catheter showed better performance using a distal protection filter in this in vitro experiment, and its use might be more effective in preventing distal embolisms in combination with a distal protection filter. (Cardiol J 2016; 23, 6: 667-672)

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“…When including all patients undergoing PCI for any indication, the incidence has been reported to be around 2.3-4.8%. [21][22][23][24][25][26][27][28] The reported incidence is higher in patients with STEMI and ranges from 11 to 41%. 21 The higher incidences of no reflow are documented in cases of primary PCI or intervention of the saphenous veingraft.…”

Section: -20mentioning

confidence: 99%

“…30 The clinical trials tested a number of treatment strategies for no-reflow have been conflicting and there is no definitive treatment of no-reflow once it has occurred. [31][32][33][34][35] In the absence of an effective treatment strategy, it is crucial to prevent no- reflow by knowing the predictors or risk factors of no-reflow. Previous studies have identified various predictors of no-reflow, which are different between studies, likely due to the differences in the populations being studied.…”

Section: -20mentioning

confidence: 99%

No-Reflow Phenomenon

Asghar¹,

Ahmad

Ilyas

2018

TPMJ

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ABSTRACT… Background: Profound reduction in antegrade epicardial coronary flow with concomitant ischemia is seen occasionally during percutaneous coronary intervention despite the absence of evident vessel dissection, obstruction, or distal vessel embolic cutoff. Study Design: Descriptive study. Setting: Khatum-un-Nabyeen Heart Center for percutaneous coronary intervention. Period: January 2016 and December 2016. Methods and Results: Both males and females with age 30 years or more, presented. Patients with coronary angiograms suggestive of percutaneous coronary intervention were included in the study by using nonprobability, purposive sampling technique. Following ethical and research approval from the hospital administration, clinical profile of the patients was documented. Patients presented with acute coronary syndrome as well as patients with stable coronary artery disease requiring coronary intervention based on clinical, ECG, non-invasive test or coronary angiogram were enrolled in the study. Patients with previous history of PCI or CABG were also included in the study. Pregnant patients were excluded from the study. The objective of this study is to find out the incidence of no reflow phenomenon during PCI in our population. The TIMI flow grade was determined for each treated vessel. The criteria for no-reflow was development of substantial flow reduction (less than TIMI 3 flow) in the absence of apparent dissection, thrombosis, or distal vessel cutoff suggestive of macroembolization. SPSS version 16.0 was used for analyzing the data. Frequency and percentages were used for categorical variables. Mean±SD was used for numerical variables. Data were presented in the form of tables. Conclusions: The no-reflow phenomenon, reduction in distal flow without apparent dissection or distal embolization -occurs in 2.25% of coronary interventions.

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

Abstract: The routine use of distal protection by a filterwire system during primary PCI does not seem to improve microvascular perfusion, limit infarct size, or reduce the occurrence of MACCE.

Cited by 138 publications

References 35 publications

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

In vitro assessment of six aspiration catheters using a distal protection filter

No-Reflow Phenomenon

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