Prevention of distal embolization during directional coronary atherectomy

Although directional coronary atherectomy (DCA) is designed to effectively reduce plaque volume by debulking in patients with ischemic heart disease, excision of fibroatheroma has potential to cause distal embolization and periprocedural myocardial infarction. The patients had intravascular ultrasound-derived attenuated plaques in the culprit lesions. A DCA catheter was inserted over a filter-based embolic protection device. After DCA, filter no-reflow phenomenon occurred, and embolized debris was retrieved by the filter device. We describe the novel use of a filter-based embolic protection device during intravascular imaging-guided DCA, particularly in patients at high risk of distal embolization. <Learning objective: The presence of intravascular ultrasound-derived attenuated plaques is at increased risk of distal embolization of debris and periprocedural myocardial infarction during directional atherectomy. A filter-based embolic protection device is available during intracoronary imaging-guided directional coronary atherectomy, particularly in patients at high risk of distal embolization.>.