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Current status of distal embolization in percutaneous coronary intervention: mechanical and pharmacological strategies

    Joost DE Haeck

    † Author for correspondence

    Academic Medical Center, University of Amsterdam, Department of Cardiology, PO BOX 22660, 1105 AZ Amsterdam, The Netherlands.

    ,
    Niels JW Verouden

    Academic Medical Center, University of Amsterdam, Department of Cardiology, PO BOX 22660, 1105 AZ Amsterdam, The Netherlands.

    ,
    José PS Henriques

    Academic Medical Center, University of Amsterdam, Department of Cardiology, PO BOX 22660, 1105 AZ Amsterdam, The Netherlands.

    &
    Karel T Koch

    Academic Medical Center, University of Amsterdam, Department of Cardiology, PO BOX 22660, 1105 AZ Amsterdam, The Netherlands.

    Published Online:https://doi.org/10.2217/fca.09.25

    Distal embolization during percutaneous coronary intervention for acute myocardial infarction or saphenous vein graft disease may result in microvascular obstruction and the ‘no-reflow’ phenomenon. The incidence of distal embolization ranges from 2 to 42% in saphenous vein graft intervention and from 6 to 15% in primary percutaneous coronary intervention and is associated with impaired myocardial perfusion and poor outcome. Several mechanical and pharmacological strategies have been proposed to prevent or to treat embolization in percutaneous coronary intervention and have been tested in clinical trials. The pivotal role of distal embolization in the pathophysiology of microvascular obstruction will lead to the further development of preventive and therapeutic strategies. Strategies to counteract distal embolization and future directions are discussed in this review.

    Bibliography Papers of special note have been highlighted as: ▪ of interest ▪▪ of considerable interest

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