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.
|
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 |
|
This article has been cited by other articles:

|
 |

|
 |
 
A. Okamura, H. Ito, K. Iwakura, T. Kurotobi, Y. Koyama, M. Date, Y. Higuchi, K. Inoue, and K. Fujii
Clinical Implications of Distal Embolization During Coronary Interventional Procedures in Patients With Acute Myocardial Infarction: Quantitative Study With Doppler Guidewire
J. Am. Coll. Cardiol. Intv.,
June 1, 2008;
1(3):
268 - 276.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. Di Mario and G. Ferrante
Embolization: The "Dark Side" of Percutaneous Coronary Interventions
J. Am. Coll. Cardiol. Intv.,
June 1, 2008;
1(3):
277 - 278.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. K. Shah
Distal Embolization After Percutaneous Coronary Interventions: Prediction, Prevention, and Relevance
J. Am. Coll. Cardiol.,
October 23, 2007;
50(17):
1647 - 1648.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
T. Kawamoto, H. Okura, Y. Koyama, I. Toda, H. Taguchi, K. Tamita, A. Yamamuro, Y. Yoshimura, Y. Neishi, E. Toyota, et al.
The Relationship Between Coronary Plaque Characteristics and Small Embolic Particles During Coronary Stent Implantation
J. Am. Coll. Cardiol.,
October 23, 2007;
50(17):
1635 - 1640.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. Lerman, D. R. Holmes, J. Herrmann, and B. J. Gersh
Microcirculatory dysfunction in ST-elevation myocardial infarction: cause, consequence, or both?
Eur. Heart J.,
April 1, 2007;
28(7):
788 - 797.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. Bahrmann, G. S. Werner, G. Heusch, M. Ferrari, T. C. Poerner, A. Voss, and H. R. Figulla
Detection of Coronary Microembolization by Doppler Ultrasound in Patients With Stable Angina Pectoris Undergoing Elective Percutaneous Coronary Interventions
Circulation,
February 6, 2007;
115(5):
600 - 608.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. Boivie, M. Hansson, and K. G. Engstrom
Intraluminal aortic manipulation by means of intra-aortic filter, cannulation, and external clamp maneuvers evaluated versus dislodged embolic material
J. Thorac. Cardiovasc. Surg.,
February 1, 2006;
131(2):
283 - 289.
[Abstract]
[Full Text]
[PDF]
|
 |
|
|