PCI complications: distal embolization: Difference between revisions

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Latest revision as of 16:43, 3 May 2014

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

100% O2, Narcotics, Suction vs hemopump, and Verapamil

Distal Embolization Examples

Case 1

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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. |access-date= requires |url= (help)

Template:WikiDoc Sources

[pmid8187116-1] 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. |access-date= requires |url= (help)

[1]

@@ Line 4: / Line 4: @@
 ==Overview==
-[[Distal]] [[embolization]] during [[percutaneous coronary intervention]] is defined as occlusion of an instrumented vessel or branch due to downstream movement of either [[thrombus]], [[atheroma]], a dislodged wire, 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]].
+[[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]].
-==Distal Embolization==
+==Causes==
-===Causes===
+*[[Thrombus]] (from a thrombotic culprit lesion or a [[coronary guidewire]] or other equipment in the [[coronary artery]])
-*Often from manifold injections ([[contrast]] or flush); increase risk with pressurized flush
+*[[Atheroma]]
+*An undeployed stent
+*Fracture of the [[distal]] tip of a [[coronary guidewire]]
+*Air bubbles from manifold injections
-===Epidemiology and Demographics===
+==Epidemiology and Demographics==
-Distal embolization occurs in approximately 10% of patients with an [[acute myocardial infarction]] undergoing PCI. [[Embolic]] [[complication]]s occur more often in patients with [[acute MI]] and in patients undergoing balloon angioplasty of [[saphenous vein graft]] [[lesion]]s, particularly those with recent [[occlusion]].
+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]].
 ===Diagnosis===