CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY
Detection of embolic particles with the Doppler guide wire during coronary intervention in patients with acute myocardial infarction
Efficacy of distal protection device
Atsunori Okamura, MD*,
Hiroshi Ito, MD, FACC*,*,
Katsuomi Iwakura, MD*,
Shigeo Kawano, MD*,
Koichi Inoue, MD*,
Yoshihiro Maekawa, MD*,
Toshio Ogihara, MD and
Kenshi Fujii, MD*
* Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
Department of Geriatric Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
Manuscript received July 18, 2004;
accepted September 28, 2004.
* Reprint requests and correspondence: Dr. Hiroshi Ito, Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan (Email: itomd{at}osk4.3web.ne.jp).
OBJECTIVES: We investigated whether embolic particles could be detected as high-intensity transient signals (HITS) with a Doppler guide wire during percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) We also assessed whether these signals could be reduced using a distal protection (DP) device.
BACKGROUND: Embolization of thrombi and plaque components to the microcirculation is a major complication of PCI in patients with AMI. Embolic particles running in the cerebral artery are detected as HITS by transcranial Doppler ultrasound.
METHODS: We prospectively studied 16 consecutive patients with AMI who underwent direct PCI within 24 h after the onset of symptoms. A PercuSurge GuardWire (MedtronicAVE, Santa Rosa, California) was used as the DP device. Eight patients were randomly assigned to the non-DP group, and the remaining eight were assigned to the DP group. Coronary flow velocity was recorded continuously from before the first balloon inflation to after balloon deflation.
RESULTS: All patients in the non-DP group had HITS detected (12 ± 9 counts) within five consecutive beats (4 ± 1 beat) after balloon deflation, but none were detected in any of the patients in the DP group.
CONCLUSIONS: The Doppler guide wire can be used to visually detect and count emboli as HITS, and the DP device is effective for prevention of distal embolization.
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Abbreviations and Acronyms
| | AMI = acute myocardial infarction | | DP = distal protection | | EMERALD = Enhanced Myocardial Efficacy and Removal by Aspiration of Liberalized Debris | | HITS = high-intensity transient signals | | PCI = percutaneous coronary intervention | | TIMI = Thrombolysis In Myocardial Infarction |
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