PCI complications: distal embolization

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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 occlusion of an instrumented vessel or branch due to downstream movement of either thrombus, atheroma, a dislodged wire, an undeployed stent or air. 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

• Often from manifold injections (contrast or flush); increase risk with pressurized flush

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 occlusion.

Diagnosis

Coronary Angiography: Distal Embolization

Treatment

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

References

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