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Published on: September 22, 2020
Distal embolization during primary angioplasty: histopathologic features and predictability
Ugo Limbruno1, Marco De Carlo, Sabina Pistolesi
1Cardiovascular Department, Livorno Hospital, ASL6, Livorno, Italy.
Insights
Distal embolization is common during primary percutaneous coronary interventions (PCI). High thrombus burden on angiography predicts embolization extent, which mainly comprises plaque and thrombi fragments.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Distal embolization during primary percutaneous coronary interventions (PCI) can impair myocardial reperfusion.
- Understanding the prevalence and characteristics of embolization is crucial for improving outcomes.
Purpose of the Study:
- To evaluate the prevalence and features of distal embolization during primary PCI.
- To identify clinical and angiographic predictors of embolization and its composition.
Main Methods:
- 46 acute myocardial infarction patients underwent primary PCI with a filter-based distal protection device.
- Histopathologic analysis of retrieved embolic fragments assessed composition and volume.
- Correlation with baseline clinical and angiographic variables was performed.
Main Results:
- Embolic material was recovered in 89% of patients, with a mean debris volume of 1.2 mm³.
- Prevalent components included organized thrombus (47%), fresh thrombus (29%), and plaque fragments (24%).
- Angiographic signs of high thrombus burden independently predicted debris volume (OR 15.8, P < .005).
Conclusions:
- Distal embolization is frequent in primary PCI, primarily composed of plaque and thrombi.
- High baseline thrombus burden is the sole significant predictor of embolization extent.
- Embolic material composition suggests limited responsiveness to antiplatelet drugs.
Background:
Distal embolization during primary percutaneous coronary interventions (PCIs) may affect myocardial reperfusion. We evaluated the prevalence and features of embolization during primary PCI and its relationship with clinical and angiographic variables.
Methods:
Forty-six consecutive patients with acute myocardial infarction underwent primary PCI with a filter-based distal protection device. Histopathologic analysis was performed on retrieved embolic fragments, assessing the presence and relative amount of fibrin, necrosis, lipid droplets, collagen, mucopolysaccharides, and leukocytes, as well as the total debris volume. Such variables were related to baseline clinical and angiographic variables.
Results:
Embolic material was recovered in 41 (89%) of 46 cases, with a mean total debris volume of 1.2 +/- 2.2 mm3. Prevalent histopathologic patterns were organized thrombus (47%), fresh thrombus (29%), and plaque fragments (24%). At multivariate analysis, none of the baseline clinical variables considered significantly predicted the total debris volume. Among angiographic variables, angiographic signs of high thrombus burden (cut-off coronary occlusion pattern or large intracoronary minus image) independently predicted the total debris volume at multivariate analysis (odds ratio 15.8, P < .005). Compared with its nonuse, abciximab did not affect the total number and the mean total volume of embolized material (15 +/- 16 vs 10 +/- 8 fragments, 1.5 +/- 2.5 vs 1.0 +/- 1.9 mm3, respectively, for both P > .20), or its qualitative composition.
Conclusions:
Distal embolization occurs in most patients during primary PCI and mainly consists of plaque fragments and partially organized thrombi, which are likely to be scarcely responsive to antiplatelet drugs. Baseline angiographic signs of a high thrombus burden are the only significant predictors of the extent of distal embolization.