Advertisement

Distal Protection Devices

  • David R. HolmesJr.
Chapter

Abstract

The role and importance of distal embolization in complications arising during percutaneous interventions are now considered well established; however, this is a relatively new concept [1]. Early in the evolution of interventional cardiology, distal embolization was not thought to be a significant problem [2,3]. Instead, the mechanism of dilatation was conceptualized as analogous to “stepping onto a layer of snow,” which was then compressed, with the procedure leading to larger lumen size without injuring the wall itself and without embolization.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Topol EJ, Yadav JS: Recognition of the importance of embolization in atherosclerotic vascular disease. Circulation 2000, 101:570–580.PubMedCrossRefGoogle Scholar
  2. 2.
    Colavita PG, Ideker RE, Reimer KA, et al.: The spectrum of pathology associated with percutaneous transluminal coronary angioplasty during acute myocardial infarction. J Am Coll Cardiol 1986, 8:855–860.PubMedCrossRefGoogle Scholar
  3. 3.
    de Morais CF, Lopez EA, Checchi H, et al.: Percutaneous transluminal coronary angioplasty: histopathological analysis of nine necropsy cases. Virchows Arch (A) 1986, 410:195–202.CrossRefGoogle Scholar
  4. 4.
    Saber RS, Edwards WD, Holmes DR, et al.: Balloon angioplasty of aorto-coronary saphenous vein bypass grafts: a histopathologic study of six grafts from five patients, with emphasis on restenosis and embolic complications. J Am Coll Cardiol 1988, 12:1501–1509.PubMedCrossRefGoogle Scholar
  5. 5.
    Saber RS, Edwards WD, Bailey KR, et al.: Coronary embolization after balloon angioplasty and thrombolytic therapy: an autopsy study of 32 cases. J Am Coll Cardiol 1993, 22:1283–1288.PubMedCrossRefGoogle Scholar
  6. 6.
    Kong TQ, Davidson CJ, Meyers SN, et al.: Prognostic implication of creatine kinase elevation following elective coronary artery interventions. JAMA 1997, 277:461–466.PubMedCrossRefGoogle Scholar
  7. 7.
    Abdelmeguid AE, Ellis SG, Sapp SK, et al.: Defining the appropriate threshold of creatine kinase elevation after percutaneous coronary interventions. Am Heart J 1996, 131:1097–1105.PubMedCrossRefGoogle Scholar
  8. 8.
    Califf RM, Abdelmeguid AE, Kuntz RE, et al.: Myonecrosis after revascularization procedures. J Am Coll Cardiol 1998, 31:241–251.PubMedCrossRefGoogle Scholar
  9. 9.
    Holmes DR Jr, Berger PB: Troponisms, necrosettes, enzyme leaks, creatine Phosphokinase bumps, and infarctlets: What’s behind this new lexicon and what does it add? Circulation 2001, 104:627–629.PubMedCrossRefGoogle Scholar
  10. 10.
    Farb A, Roberts DK, Pichard AD, et al.: Coronary artery morphologic features after coronary rotational atherectomy: insights into mechanisms of lumen enlargement and embolization. Am Heart J 1995, 129:1058–1067.PubMedCrossRefGoogle Scholar
  11. 11.
    Bhatt DL, Topol EJ: Periprocedural myocardial infarction and emboli protection. In Textbook of Interventional Cardiology. Philadelphia: WB Saunders; 2003:251–266.Google Scholar
  12. 12.
    Frink RJ, Ostrach LH, Rooney PA, Rose J: Coronary thrombosis, ulcerated athersclerotic plaques and platelet/fibrin microemboli in patients dying with acute coronary disease: a large autopsy study. J Clin Invest 1990, 2:199–210.Google Scholar
  13. 13.
    Piana RN, Paik GY, Moscucci M, et al.: Incidence and treatment of ‘no-reflow’ after percutaneous coronary intervention. Circulation 1994, 89:2514–2518.PubMedCrossRefGoogle Scholar
  14. 14.
    Ito H, Maruyama A, Iwakura K, et al.: Clinical implications of the ‘no reflow’ phenomenon: a predictor of complications and left ventricular remodeling in reperfused anterior wall myocardial infarction. Circulation 1996, 93:223–228.PubMedCrossRefGoogle Scholar
  15. 15.
    Gibson CM, Cannon CP, Murphy SA, et al.: Relationship of TIMI myocardial perfusion grades, flow grades, frame count, and percutaneous coronary intervention to long-term outcomes after thrombolytic administration in acute myocardial infarction. Circulation 2002, 105:1909–1913.PubMedCrossRefGoogle Scholar
  16. 16.
    Gibson CM, Cannon CP, Daley WL, et al.: TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 1996, 93:879–888.PubMedCrossRefGoogle Scholar
  17. 17.
    Koch KC, von Dahl J, Kleinhans E, et al.: Influence of a platelet GP IIIb/IIIa receptor antagonist on myocardial hypoperfusion during rotational atherectomy as assessed by myocardial Tc-99m sestambi scintigraphy. J Am Coll Cardiol 1999, 33:998–1004.PubMedCrossRefGoogle Scholar
  18. 18.
    Ricciardi MJ, Wu E, Davidson CJ, et al.: Visualization of discrete microinfarction after percutaneous coronary intervention associated with mild creatine kinase-MB elevation. Circulation 2001, 103:2780–2783.PubMedCrossRefGoogle Scholar
  19. 19.
    Webb JG, Carere RG, Virmani R, et al.: Retrieval and analysis of particulate debris after saphenous vein graft intervention. J Am Coll Cardiol 1999, 34:468–475.PubMedCrossRefGoogle Scholar
  20. 20.
    Bairn DS, Wahr D, George B, et al.: Randomized trial of a distal embolic protection device during percutaneous intervention of saphenous vein aorto-coronary bypass grafts. Circulation 2002, 105:1285–1290.Google Scholar
  21. 21.
    Steve GW, Rogers C, Ramee S, et al.: Distal filter protection during saphenous vein graft stenting: technical and clinical correlation of effusion. J Am Coll Cardiol 2002, 40:1882–1888.CrossRefGoogle Scholar
  22. 22.
    Grube E, Gerckens U, Young A, et al.: Prevention of distal embolization during coronary angioplasty in saphenous vein grafts and native vessels using porous filter protection. Circulation 2001, 104:2436–2441.PubMedCrossRefGoogle Scholar
  23. 23.
    Reimers B, Corvaja N, Moshiri S, et al.: Cerebral protection with filter devices during carotid artery stenting. Circulation 2001, 104:12–15.PubMedCrossRefGoogle Scholar
  24. 24.
    Yadav, J et al.: SAPPHIRE Study of Angioplasty with Distal Protection in Patients at High Risk for Endarterectomy, Late Breaking Clinical Trial, AHA 2002.Google Scholar

Copyright information

© Springer Science+Business Media New York 2003

Authors and Affiliations

  • David R. HolmesJr.

There are no affiliations available

Personalised recommendations