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Coronary microembolization
G Heusch1, R Schulz, D Baumgart
1Abteilungen für Pathophysiologie und Kardiologie des Zentrums für Innere Medizin, Universitätsklinikum Essen, Hufelandstrasse 55, 45122 Essen, Germany.
Insights
Atherosclerotic plaque rupture can cause coronary microembolization, leading to arrhythmias and heart dysfunction. This review covers evidence and prevention strategies for this condition.
Area of Science:
- Cardiovascular Medicine
- Pathology
- Interventional Cardiology
Background:
- Atherosclerotic plaque rupture is central to acute coronary syndromes and interventions.
- Plaque rupture can lead to microembolization into the coronary microcirculation, not always complete occlusion.
- Coronary microembolization is implicated in sudden death and milder forms of coronary artery disease.
Purpose of the Study:
- To summarize morphologic, experimental, and clinical evidence of coronary microembolization.
- To highlight the clinical features and pathophysiology of coronary microembolization.
- To discuss prevention strategies for coronary microembolization.
Main Methods:
- Review of morphologic evidence in deceased patients with coronary artery disease.
- Analysis of experimental pathophysiology in animal models of acute coronary syndromes and heart failure.
- Synthesis of clinical evidence, including key features and prevention methods.
Main Results:
- Morphologic evidence supports coronary microembolization in patients with coronary artery disease.
- Animal models elucidate the pathophysiology of microembolization in acute coronary syndromes and heart failure.
- Clinical features include arrhythmias, contractile dysfunction, infarctlets, and reduced coronary reserve.
Conclusions:
- Coronary microembolization is a significant consequence of atherosclerotic plaque rupture.
- Understanding its pathophysiology and clinical manifestations is crucial.
- Mechanical protection devices and glycoprotein IIb/IIIa antagonism show promise for prevention.
Abstract:
Atherosclerotic plaque rupture is a key event in the pathogenesis of acute coronary syndromes and during coronary interventions. Atherosclerotic plaque rupture does not always result in complete thrombotic occlusion of the entire epicardial coronary artery with subsequent acute myocardial infarction; however, in milder forms it may result in the embolization of atherosclerotic and thrombotic debris into the coronary microcirculation. The present report summarizes the available morphologic evidence for coronary microembolization in patients who died of coronary artery disease, especially sudden death. The report then goes on to address the experimental pathophysiology of coronary microembolization in animal models of acute coronary syndromes and heart failure. Finally, the report presents the available clinical evidence for coronary microembolization, highlights its key features--arrhythmias, contractile dysfunction, infarctlets and reduced coronary reserve--and addresses prevention by mechanical protection devices and glycoprotein IIb/IIIa antagonism.