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 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. 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

References

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