PCI complications: distal embolization

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hardik Patel, M.D., Sapan Patel M.B.B.S

Overview

Distal embolization during percutaneous coronary intervention is defined as either partial or complete occlusion of an instrumented major epicardial coronary artery or a branch due to downstream movement of either thrombus, atheroma, fracture of the distal tip of a coronary guidewire, an undeployed stent or air.^[1] It is manifested clinically as either chest pain, ST segment elevation, no reflow during the procedure and / or a rise in biomarkers of myonecrosis (CK-MB or troponin) following the PCI.

Thrombus (from a thrombotic culprit lesion or a coronary guidewire or other equipment in the coronary artery)
Atheroma
An undeployed stent
Fracture of the distal tip of a coronary guidewire
Air bubbles from manifold injections

Distal embolization occurs in approximately 10% of patients with an acute myocardial infarction undergoing PCI. Embolic complications occur more often in patients with acute MI and in patients undergoing balloon angioplasty of saphenous vein graft lesions, particularly those with recent total occlusion.

↑ Ishizaka N, Issiki T, Saeki F, Furuta Y, Ikari Y, Yamaguchi T (1994). “Predictors of myocardial infarction after distal embolization of coronary vessels with percutaneous transluminal coronary angioplasty. Experience of 21 consecutive patients with distal embolization”. Cardiology. 84 (4–5): 298–304. PMID 8187116. |access-date= requires |url= (help)