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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

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