Related Experiment Video
Updated: Sep 27, 2026
Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Predicting angiographic distal embolization following percutaneous coronary intervention in patients with acute
Daiju Fukuda1, Atsushi Tanaka, Kenei Shimada
1Department of Internal Medicine and Cardiology, Graduate School of Medicine, Osaka City University, Osaka, Japan. daiju@qg7.so-net.ne.jp
Insights
Intracoronary mobile mass detected by intravascular ultrasound (IVUS) before percutaneous coronary intervention (PCI) predicts distal embolization in acute myocardial infarction (AMI) patients. This finding aids in selecting patients who may benefit from distal protection devices during PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Percutaneous coronary intervention (PCI) is a key therapy for acute myocardial infarction (AMI).
- Distal embolization remains a significant complication of PCI, impacting patient outcomes.
- Preventive strategies for distal embolization are evolving, necessitating better risk stratification.
Purpose of the Study:
- To investigate the relationship between intravascular ultrasound (IVUS) identified lesion morphology and angiographic distal embolization post-PCI in AMI patients.
- To identify predictors of distal embolization to guide the use of protective devices.
Main Methods:
- Intravascular ultrasound (IVUS) imaging was performed in 140 consecutive AMI patients prior to intervention.
- Patients were categorized into embolization and non-embolization groups based on angiographic findings.
- Clinical, IVUS, and angiographic data were analyzed using multivariate logistic regression.
Main Results:
- Distal embolization occurred in 9% of patients.
- The embolization group showed significantly higher peak creatine kinase levels, incidence of angiographic thrombus, and intracoronary mobile mass on IVUS.
- Intracoronary mobile mass detected by IVUS was a strong predictor of distal embolization (OR 53, p <0.01).
Conclusions:
- Intracoronary mobile mass identified by IVUS is a significant predictor of distal embolization after PCI in AMI.
- Pre-PCI IVUS assessment can identify high-risk patients who may benefit from distal protection devices.
- This approach may help reduce infarct size and improve outcomes in AMI patients undergoing PCI.
Abstract:
The aim of this study was to investigate the relation between lesion morphology identified by intravascular ultrasound (IVUS) before intervention and angiographic distal embolization after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). PCI for AMI has already been established as beneficial therapy, although some complications remain unresolved. Distal embolization is 1 of the important complications of PCI. Recently, some new devices have been developed for the prevention of distal embolization. However, few studies exist that look into the relation between lesion morphology and distal embolization. IVUS was performed safely in 140 consecutive patients with AMI before coronary intervention. No patient received thrombolytic therapy. From the incidence of angiographic distal embolization, patients were divided into 2 groups--an embolization group and a nonembolization group--and clinical background, IVUS, and angiographic information were evaluated. Distal embolization was observed in 12 patients (9%). Peak creatine kinase levels (3,877 +/- 2,285 vs 2,293 +/- 1,792 IU/L, p <0.05) and the incidence of angiographic thrombus (25% vs 5%, p <0.05) and intracoronary mobile mass detected by IVUS (75% vs 16%, p <0.001) were higher for patients in the embolization group. From the multivariate logistic regression analysis, only an intracoronary mobile mass detected by IVUS emerged as a predictor of distal embolization (odds ratio 53, 95% confidence interval 2.7 to 1,040, p <0.01). Patients with an intracoronary mobile mass detected by IVUS are prone to distal embolization after PCI and larger infarction. IVUS imaging before PCI may be useful for determining which patients need a distal protection device.
