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A fresh look at coronary microembolization

Petra Kleinbongard1, Gerd Heusch2

  • 1Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany.

Nature Reviews. Cardiology
|November 17, 2021
PubMed

Insights

Coronary microembolization, caused by plaque erosion, links culprit lesions to non-ST-segment elevation myocardial infarction. This review explores microembolization mechanisms and treatments for improved outcomes.

Area of Science:

  • Cardiovascular Medicine
  • Pathophysiology
  • Interventional Cardiology

Background:

  • Mechanical stress on coronary plaques releases debris and soluble substances, obstructing microcirculation and causing endothelial dysfunction.
  • This leads to microinfarcts and myocardial contractile dysfunction, contributing to acute coronary syndromes.
  • Non-ST-segment elevation myocardial infarction (NSTEMI) incidence has increased, with plaque erosion becoming a recognized key mechanism.

Purpose of the Study:

  • To characterize the features and mechanisms of coronary microembolization.
  • To discuss clinical trials of drugs and devices for prevention and treatment of coronary microembolization.
  • To propose coronary microembolization as a link between plaque erosion and NSTEMI.

Main Methods:

  • Review of existing literature on coronary microembolization.
  • Analysis of mechanisms involving particulate debris and soluble substances.
  • Discussion of clinical trial data for preventative and therapeutic strategies.

Main Results:

  • Coronary microembolization involves physical obstruction and soluble substance-induced dysfunction, leading to myocardial damage.
  • Current protective devices show modest benefits, and treatments primarily rely on antiplatelet and vasodilator agents.
  • Plaque erosion is increasingly recognized as a cause of NSTEMI, linked by microembolization.

Conclusions:

  • Coronary microembolization is a critical factor in the pathophysiology of NSTEMI, particularly in cases of plaque erosion.
  • Further research and improved therapeutic strategies are needed to address the impact of microembolization.
  • Understanding these mechanisms can guide the development of more effective treatments for acute coronary syndromes.

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