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Updated: Jun 22, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Clinical implications of distal embolization during coronary interventional procedures in patients with acute
Atsunori Okamura1, Hiroshi Ito, Katsuomi Iwakura
1Division of Cardiology, Sakurabashi Watanabe Hospital, Kita-ku, Osaka, Japan.
Insights
Distal embolization during percutaneous coronary intervention (PCI) is common, with most embolic particles generated after stenting. Increased embolic signals correlate with reduced coronary blood flow and poorer left ventricular function recovery in acute myocardial infarction patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Distal embolization is a significant complication following percutaneous coronary intervention (PCI).
- High-intensity transient signals (HITS) detected by Doppler guidewire (DGW) indicate embolic particle generation during PCI.
Purpose of the Study:
- To investigate the timing and quantity of embolic particle generation during PCI.
- To examine the relationship between embolic burden, coronary blood flow, and myocardial damage.
Main Methods:
- Prospective study of 37 acute myocardial infarction (MI) patients undergoing PCI.
- Utilized Doppler guidewire (DGW) monitoring throughout balloon angioplasty, stenting, and post-dilatation.
- Assessed Left Ventricular Ejection Fraction (LVEF) and Regional Wall Motion (RWM) at baseline and follow-up.
Main Results:
- Embolic signals (HITS) were detected in 35 of 37 patients, with the highest frequency observed post-stenting.
- A significant correlation was found between total HITS and corrected Thrombolysis In Myocardial Infarction frame count.
- A weak inverse correlation existed between HITS and improvements in LVEF and RWM.
Conclusions:
- Distal embolization is frequent during PCI in acute MI patients, predominantly occurring after stenting.
- Increased embolic burden (HITS) is linked to impaired coronary blood flow.
- Higher embolic signals show a weak association with suboptimal recovery of left ventricular function.
Objectives:
This study sought to investigate the timing and amount of embolic particles generation during the percutaneous coronary intervention (PCI) procedure and studied the relationship between embolic burden and coronary blood flow and myocardial damage.
Background:
Distal embolization is a major complication of PCI. The Doppler guidewire (DGW) can detect the embolic particles as high-intensity transient signals (HITS) during the PCI procedure.
Methods:
We prospectively studied 37 patients with acute myocardial infarction (MI). Under monitoring with the DGW, we performed first and second balloon angioplasty, followed by stenting and post-high-pressure dilatation. Left ventricular ejection fraction (LVEF) (%) and regional wall motion (RWM) (standard deviation/chord) were measured on days 1 and 22.
Results:
The HITS were detected in 35 of 37 patients. The number of HITS was the greatest after stenting (16 +/- 18) followed by first balloon inflation (5 +/- 4). There was a significant correlation between the total number of HITS and the corrected Thrombolysis In Myocardial Infarction frame count (r = 0.52, p = 0.003) and a significant weak inverse correlation between the total number of HITS and changes in LVEF and RWM (r = 0.37, p = 0.03 and r = 0.35, p = 0.04, respectively).
Conclusions:
Distal embolization is common during PCI in patients with acute MI, and the majority of HITS were observed after stenting. An increase in the total number of HITS is associated with reduced coronary blood flow, and is weakly associated with poor recovery of left ventricular function.
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