Embolization after percutaneous coronary intervention in acute coronary syndrome: Saphenous vein grafts versus native coronary arteries

• Published in: Herz 2015-03, Vol.40 (Suppl 1), p.36-42
• Main Authors: Karakyriou, M., Hadjimiltiades, S., Meditskou, S., Nenopoulou, E., Efthimiadis, G., Vogazianos, P., Karvounis, C., Styliadis, I.
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - therapy; Blood Vessel Prosthesis; Cardiology; Combined Modality Therapy - methods; Coronary Vessels - transplantation; Embolization, Therapeutic - methods; Female; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Percutaneous Coronary Intervention - instrumentation; Saphenous Vein - transplantation; Stents; Treatment Outcome
• ISSN: 0340-9937; 1615-6692
• DOI: 10.1007/s00059-014-4184-0

Aims The aim of this study was to assess the occurrence of distal embolization and to quantify the amount of embolic material captured during stent implantation in native coronary arteries, as compared with saphenous vein grafts (SVG) in patients at different time periods after an acute coronary syndrome. Patients and methods In all, 104 patients presenting with unstable or stable angina underwent percutaneous coronary intervention (PCI) in 107 vessels and stent implantation in 112 lesions, 53 % of which were in SVG. Results Device deployment and retrieval was successful in 111 lesions. Embolic material was detected in 74 % of the protection devices. Early PCI, during a 2-week period after the last ischemic episode, was associated with larger embolic load, especially in the right coronary artery. The length of the lesion was the only preprocedural independent variable that was found to be a significant predictor for the presence of emboli ( p  = 0.002). The stent diameter and the maximum dilatation pressure were the two procedural variables found to be significant predictors for the presence of emboli ( p  = 0.025 and p  = 0.008, respectively). The irregularity of the lesion and the number of stents deployed were found to have a predictive correlation to the total area of the embolic particles ( p  = 0.04 and p  = 0.005, respectively). Conclusion Distal embolization of atherosclerotic debris is a frequent phenomenon after PCI not only in SVG but also in native vessels. The amount of embolic material seems to be related to the atherosclerotic burden of the vessel and to the early timing of the procedure as related to acute coronary syndrome.