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Updated: Oct 13, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Use of an emboli containment and retrieval system during percutaneous coronary angioplasty in native coronary
G Sütsch1, W Kiowski, A Bossard
1Department of Medicine, University Hospital, Zurich. gabor.suetsch@dim.usz.ch
Insights
A new protection device effectively captures debris during percutaneous coronary interventions, preventing distal embolization. This novel system shows promise in reducing post-procedural complications in native coronary arteries.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Engineering
Background:
- Distal embolization during percutaneous coronary revascularization can increase post-procedural morbidity and mortality.
- Effective prevention strategies are crucial for improving patient outcomes in coronary interventions.
Purpose of the Study:
- To evaluate the feasibility and efficacy of a novel emboli containment and retrieval system.
- To assess the system's ability to prevent distal embolization during percutaneous coronary angioplasty and stenting in native coronary arteries.
Main Methods:
- A newly developed emboli containment and retrieval system was used in 39 patients undergoing percutaneous coronary angioplasty and stenting.
- Patients presented with acute, subacute, or chronic total/subtotal occlusion, or severe stenosis with unstable angina.
- The system was employed during balloon inflation, with cumulative inflation times up to 25 minutes.
Main Results:
- The procedure was uneventful in all patients, achieving good angiographic results and normal postprocedural flow.
- Visible debris, including necrotic core, inflammatory cells, cholesterol, and thrombi (up to 12 mm), was found in aspirates from 31 patients.
- Anginal pain occurred in 19 patients but did not lead to procedural interruption or hemodynamic instability.
Conclusions:
- The protection device is feasible for use in native coronary arteries to prevent distal embolization of particulate matter.
- This system has the potential to reduce complications such as no-reflow and infarction.
- Further clinical trials are necessary to confirm the clinical benefits of this emboli protection system.
Background:
Prevention of distal embolisation during percutaneous coronary revascularisation may be necessary to reduce postinterventional morbidity and mortality.
Methods And Results:
We employed a newly developed emboli containment and retrieval system in native coronary arteries during percutaneous coronary angioplasty and stenting in 39 selected patients (mean age 58.9 +/- 10.1 years, 11 females) presenting with acute (n = 22; 8 LAD, 3 LCX, 11 RCA), subacute (n = 7; 2 LAD, 2 LCX, 3 RCA) or chronic (n = 6; 2 LAD, 4 RCA) total or subtotal occlusion of an infarct-related vessel, or with severe stenosis and symptoms of unstable angina (n = 4; 2 LAD, 2 RCA). Protection device-assisted angioplasty with stent implantation was uneventful in all patients with good angiographic results and normal postprocedural flow. Intermittent aggravation of anginal pain during inflation of the occlusive balloon (from 2.5 to a maximum of 25 minutes cumulative inflation time) was observed in 19 of the 36 conscious patients (7 with acute, 7 with subacute and 3 with chronic occlusion, and 2 with unstable angina), but caused neither interruption of distal occlusion nor haemodynamic instability. In 31 patients the aspirates contained visible debris. Histological analysis showed particles up to 12 mm in size, consisting of necrotic core, inflammatory cells, cholesterol debris, and old and fresh thrombi. In 8 patients the aspirated particles were too small to allow microscopic diagnosis or debris was absent.
Conclusions:
This preliminary report demonstrates the feasibility of using a protection device in native coronary arteries to prevent distal embolisation of particulate matter that is mobilised during percutaneous interventions. To the extent that this material contributes to the mechanisms of distal embolisation, noreflow and infarction, this device may help to reduce such complications. Appropriately designed trials are required to assess the clinical benefit of this system.
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