PCI complications: distal embolization: Difference between revisions
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{{ | __NOTOC__ | ||
{{PCI}} | |||
{{CMG}}; {{AE}} {{HP}}, {{Sapan}} | |||
== | ==Overview== | ||
[[Distal]] [[embolization]] during [[percutaneous coronary intervention]] is defined as either partial or complete occlusion of an instrumented major epicardial [[coronary artery]] or a branch due to downstream movement of either [[thrombus]], [[atheroma]], fracture of the [[distal]] tip of a [[coronary guidewire]], an undeployed stent or air.<ref name="pmid8187116">{{cite journal |author=Ishizaka N, Issiki T, Saeki F, Furuta Y, Ikari Y, Yamaguchi T |title=Predictors of myocardial infarction after distal embolization of coronary vessels with percutaneous transluminal coronary angioplasty. Experience of 21 consecutive patients with distal embolization |journal=[[Cardiology]] |volume=84 |issue=4-5 |pages=298–304 |year=1994 |pmid=8187116 |doi= |url= |accessdate=2011-12-28}}</ref> It is manifested clinically as either [[chest pain]], [[ST segment elevation]], [[no reflow]] during the procedure and / or a rise in [[biomarkers]] of [[myonecrosis]] ([[CK-MB]] or [[troponin]]) following the [[PCI]]. | |||
==Causes== | |||
*[[Thrombus]] (from a thrombotic culprit lesion or a [[coronary guidewire]] or other equipment in the [[coronary artery]]) | |||
*[[Atheroma]] | |||
*An undeployed stent | |||
*Fracture of the [[distal]] tip of a [[coronary guidewire]] | |||
*Air bubbles from manifold injections | |||
== | ==Epidemiology and Demographics== | ||
Distal embolization occurs in approximately 10% of patients with an [[acute myocardial infarction]] undergoing PCI. Embolic complications occur more often in patients with [[acute MI]] and in patients undergoing balloon angioplasty of [[saphenous vein graft]] [[lesion]]s, particularly those with recent [[total occlusion]]. | |||
Distal embolization | ===Diagnosis=== | ||
====Coronary Angiography: Distal Embolization==== | |||
[[File:Distal embolization.gif|left|250px]] | |||
<br clear="left"/> | |||
===Treatment=== | |||
*100% O2, [[Narcotic]]s, Suction vs hemopump, and [[Verapamil]] | |||
== | ==Distal Embolization Examples== | ||
===[[Distal embolization case 1|Case 1]]=== | |||
===[[Distal embolization case 2|Case 2]]=== | |||
===[[Distal embolization case 3|Case 3]]=== | |||
===[[Distal embolization case 4|Case 4]]=== | |||
===[[Distal embolization case 5|Case 5]]=== | |||
===[[Distal embolization case 6|Case 6]]=== | |||
===[[Distal embolization case 7|Case 7]]=== | |||
===[[Distal embolization case 8|Case 8]]=== | |||
===[[Distal embolization case 9|Case 9]]=== | |||
===[[Distal embolization case 10|Case 10]]=== | |||
===[[Distal embolization case 11|Case 11]]=== | |||
===[[Distal embolization case 12|Case 12]]=== | |||
===[[Distal embolization case 13|Case 13]]=== | |||
===[[Distal embolization case 14|Case 14]]=== | |||
===[[Distal embolization case 15|Case 15]]=== | |||
===[[Distal embolization case 16|Case 16]]=== | |||
===[[Distal embolization case 17|Case 17]]=== | |||
===[[Distal embolization case 18|Case 18]]=== | |||
===[[Distal embolization case 19|Case 19]]=== | |||
===[[Distal embolization case 20|Case 20]]=== | |||
==References== | ==References== | ||
{{Reflist|2}} | |||
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Latest revision as of 16:43, 3 May 2014
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Percutaneous coronary intervention Microchapters |
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PCI Complications |
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PCI in Specific Patients |
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PCI in Specific Lesion Types |
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PCI complications: distal embolization On the Web |
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American Roentgen Ray Society Images of PCI complications: distal embolization |
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Directions to Hospitals Treating Percutaneous coronary intervention |
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Risk calculators and risk factors for PCI complications: distal embolization |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hardik Patel, M.D., Sapan Patel M.B.B.S
Overview
Distal embolization during percutaneous coronary intervention is defined as either partial or complete occlusion of an instrumented major epicardial coronary artery or a branch due to downstream movement of either thrombus, atheroma, fracture of the distal tip of a coronary guidewire, an undeployed stent or air.[1] It is manifested clinically as either chest pain, ST segment elevation, no reflow during the procedure and / or a rise in biomarkers of myonecrosis (CK-MB or troponin) following the PCI.
Causes
- Thrombus (from a thrombotic culprit lesion or a coronary guidewire or other equipment in the coronary artery)
- Atheroma
- An undeployed stent
- Fracture of the distal tip of a coronary guidewire
- Air bubbles from manifold injections
Epidemiology and Demographics
Distal embolization occurs in approximately 10% of patients with an acute myocardial infarction undergoing PCI. Embolic complications occur more often in patients with acute MI and in patients undergoing balloon angioplasty of saphenous vein graft lesions, particularly those with recent total occlusion.
Diagnosis
Coronary Angiography: Distal Embolization
Treatment
Distal Embolization Examples
Case 1
Case 2
Case 3
Case 4
Case 5
Case 6
Case 7
Case 8
Case 9
Case 10
Case 11
Case 12
Case 13
Case 14
Case 15
Case 16
Case 17
Case 18
Case 19
Case 20
References
- ↑ Ishizaka N, Issiki T, Saeki F, Furuta Y, Ikari Y, Yamaguchi T (1994). "Predictors of myocardial infarction after distal embolization of coronary vessels with percutaneous transluminal coronary angioplasty. Experience of 21 consecutive patients with distal embolization". Cardiology. 84 (4–5): 298–304. PMID 8187116.
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