Abstract:

This article presents a clinical case of successful prevention of distal embolization in patient with acute ST-elevation myocardial infarction with a combination of manual thromboaspiration and distal protection. We have presented own and literature data about possible additional sourse of distal embolization (contents of cavity plaque rupture) after successful thromboaspiration during stent implantation, which was the basis of a strategy combination of manual thromboaspiration and distal protection. As a device for distal protection we used the system «Emboshield NAV6» (Abbott Vascular, USA). We have described design features of the device, knowledge of which will help to make better use of it in native coronary arteries in such situations.

Reference 

1.    Mehta R.H., Harjai K.J., Boura J. et al., for the Primary Angioplasty in Myocardial Infarction (PAMI) Investigators. Prognostic significance of transient no-reflow during primary percutaneous coronary intervention for ST-elevation acute myocardial infarction. Am. J. Cardiol. 2003; 92: 1445-1447.

2.    Niccoli G., Burzotta F., Galiuto L. et al. Myocardial no-reflow in humans. J. Am Coll. Cardiol. 2009: 21: 281-292.

3.    Piana R.N., Paik G.Y., Moscucci M. et al. Incidence and treatment of «no-reflow» after percutaneous coronary intervention. Circulation. 1994; 89: 2514-2518.

4.    Klonner R.A., Ganote C.E., Jennings R.B. The «no-reflow» phenomenon after temporary coronary occusion in the dog. J. Clin. Invest. 1974: 54: 1496-1508.

5.    Al'biero R. Oslozhnenija pri chreskozhnyh koronarnyh vmeshatel'stvah: ot prognoza k preduprezhdeniju i lecheniju. Rentgenojendovaskuljarnaja hirurgija ishemicheskoj bolezni serdca: Rukovodstvo po rentgenojendovaskuljarnoj hirurgii serdca i sosudov: V 3 t. (Pod red. L.A. Bokerija, B.G. Alekjana). M.: NCSSH im. A.N. Bakuleva RAMN. 2008; 3: 157-174 [In Russ].

6.    Burzotta F., Trani C., Romagnoli E. et al. Manual thrombus-aspiration improves myocardial reperfusion: the randomized evaluation of the effect of mechanical reduction of distal embolization by thrombus-aspiration in primary and rescue angioplasty (REMEDIA) trial. J. Am Coll. Cardiol. 2005; 46: 371-376.

7.    The Thrombolysis in Myocardial Infarction (TIMI) trial, phase I findings: TIMI Study Group. N. Engl. J. Med. 1985; 312: 932-936.

8.    Kirma C., Izgi A., Dundar C. et al. Clinical and procedural predictors of no-reflow phenomenon after primary percutaneous coronary interventions. Experience at a Single Center. Circ. J. 2008; 72: 716-721.

9.    Zalewski J., Bogaerts K., Desmet W. et al. Intraluminal thrombus in facilitated versus primary percutaneous coronary intervention: an angiographic substudy of the ASSENT-4 PCI (Assessment of the Safety and Efficacy of a New Treatment Strategy With Percutaneous Coronary Intervention) trial. J. Am. Coll. Cardiol. 2011; 57: 1867-1873.

10.  Svilaas T., Vlaar P.J., van der Horst I. et al. Thrombus aspiration during primary percutaneous coronary intervention. N. Engl. J. Med. 2008; 358: 557-567.

11.  Vlaar P.J., Svilaas G., van der Horst. et al. Cardiac death and reinfarction after 1 year in the Thrombus aspiration during primary percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1 - year follow - up study. Lancet. 2008; 371: 1915-1920.

12.  Guidelines on myocardial revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur. Heart J. 2010; 31: 2501-2555.

13.  Lee S.Y., Mintz G.S., Kim S.Y. et al. Attenuated plaque detected by intravascular ultrasound: clinical, angiographic, and morphologic features and post-percutaneous coronary intervention complication in patients with acute coronary syndromes. J. Am. Coll. Cardiol. 2009; 2(1): 65-72.

14.  Okura H., Taguchi H., Kubo T. et al. Atherosclerotic plaque with ultrasonic attenuation affects coronary reflow and infarct size in patients with acute coronary syndrome: an intravascular ultrasound study. CircJ.2007; 71: 648-653.

15.  Isshiki T., Kozuma K., Kyono H. et al. Initial clinical experience with distal embolic protection using «Filtrap’», a novel filter device with a self-expandable spiral basket in patients undergoing percutaneous coronary intervention. Cardiovasc. Intern and Ther. 2011; 26: 12-17.

16.  Markas'jan A.V., Petrushenko A.E., Val'ko A.S. i dr. Uspeshnaja aspiracija vnutrikoronarnyh trombov cherez provodnikovyj kateter HEARTRAIL II pri ostrom infarkte miokarda s pod#emom segmenta ST: tri klinicheskih sluchaja. Vest. rentgen. i radiol. 2012; 1: 38-44 [In Russ].

17.  Hadi H.M., Fraser D.G., Mamas M.A. Novel use of the Heartrail catheter as a thrombectomy Device. J. Invas. Cardiol. 2011; 23 (1): 35 - 40.

18.  Porto I., Choudhury R.P., Pillay P. et al. Filter no reflow during percutaneous coronary interventions using the Filterwire distal protection device. Int. J. Cardiol. 2006; 109: 53-58.

19.  Wu X., Mintz G.S., Xu K. et al. The Relationship Between Attenuated Plaque Identified by Intravascular Ultrasound and No-Reflow After Stenting in Acute Myocardial Infarction The HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) Trial. J. Am. Coll. Cardiol. Intv. 2011; 4: 495-502.

20.  Endo M., Hibi K., Shimizu T. et al. Impact of ultrasound attenuation and plaque rupture as detected by intravascular ultrasound on the incidence of no-reflow phenomenon after percutaneous coronary intervention in ST-segment elevation myocardial infarction. J. Am. Coll. Cardiol. Intv. 2010; 3: 540-549.

21.  Hara H., Tsunoda T., Moroi M. et al. Ultrasound attenuation behind coronary atheroma without calcication: mechanism revealed by autopsy. Acute Cardiac Care. 2006: 8: 110-112.

22.  Johnstone E., Friedl S.E., Maheshwari A. et al. Distinguishing characteristics of erythrocyte-rich and platelet-rich thrombus by intravascular ultrasound catheter system. J. Thromb. Thrombolysis. 2007; 24: 233-239.

23.  Ohshima K., Ikeda Sh., Kadota H. et al.