Interventional procedures for atherothrombosis: Pathology of retrieved material

Heart

Volumn 93, Issue 10, 2007, Pages 1301-1308

  Angelini, Annalisa ^a   Della Barbera, Mila ^a   Thiene, Gaetano ^a  

^a UNIVERSITY OF PADUA MEDICAL SCHOOL   (Italy)

Author keywords

[No Author keywords available]

Indexed keywords

IMMUNOGLOBULIN ENHANCER BINDING PROTEIN;

ANGIOPLASTY; APOPTOSIS; ARTERY; ATHEROSCLEROSIS; ATHEROTHROMBOSIS; HUMAN; PRIORITY JOURNAL; REVASCULARIZATION; REVIEW; THROMBOSIS; THROMBUS;

ATHEROSCLEROSIS; BALLOON DILATATION; CAROTID ARTERY DISEASES; CORONARY ARTERIOSCLEROSIS; HUMANS; STENTS; THROMBOSIS;

EID: 34848822523     PISSN: 13556037     EISSN: None     Source Type: Journal    
DOI: 10.1136/hrt.2004.057430     Document Type: Review

References (20)

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11. Ohki T, Roubin GS, Veith FJ, et al. Efficacy of a filter device in the prevention of embolic events during carotid angioplasty and stenting: an ex vivo analysis. J Vasc Surg 1999;30:1034-44. ▶ This study demonstrates in an ex-vivo human model that filter protection captures only some of the debris resulting from embolisation which occurs during stenting. In fact, embolic fragments not entrapped by the filter were found both at the time of stenting and during the initial passage of the guidewire through the lesion when the fiber protection was not yet inserted.
12. Angelini A, Reimers B, Della Barbera M, et al. Cerebral protection during carotid artery stenting: collection and histopathologic analysis of embolized debris. Stroke 2002;33:456-61. ▶ Filter protection during carotid artery stenting is able to collect atherothrombotic fragments produced by the squeezing of atherothrombotic lesions in a vast majority of cases. Collected debris consisted predominantly of thrombotic material, foam cells and cholesterol clefts. The procedure with protection was effective, feasible and safe.
13. Kotani J, Nanto S, Mintz GS, et al. Plaque gruel of atheromatous coronary lesion may contribute to the no-reflow phenomenon in patients with acute coronary syndrome. Circulation 2002;106:1672- 7. ▶ This paper supports the concept that the no-reflow phenomenon occurring in patients with acute coronary syndromes is mainly due to a mechanical blockage of the microcirculation produced by distal embolisation of atherosclerotic plaque fragments.
14. Roubin GS, New G, Iyer SS, et al. Immediate and late clinical outcomes of carotid artery stenting in patients with symptomatic and asymptomatic carotid artery stenosis: a 5-year prospective analysis. Circulation 2001;103:532-7.
15. Ouriel K, Wholey MH, Fayad P, et al. Feasibility trial of carotid stenting with and without an embolus protection device. J Endovasc Ther 2005;12:525-37.
16. Angelini A, Rubartelli P, Mistrorigo F, et al. Distal protection with a filter device during coronary stenting in patients with stable and unstable angina. Circulation 2004;110:515-21. ▶ Protective devices may prevent a number of potentially unfavourable events, by limiting embolisation, thereby improving outcome. The use of protective devices, especially in lesions with higher embolic potential such as those which occur in older patients and in those with unstable angina, is recommended.
17. Limbruno U, Micheli A, De Carlo M, et al. Mechanical prevention of distal embolization during primary angioplasty: safety, feasibility, and impact on myocardial reperfusion Circulation 2003;108:171-6.
18. Stone GW, Webb J, Cox DA, et al. Enhanced Myocardial Efficacy and Recovery by Aspiration of Liberated Debris (EMERALD) Investigators. Distal microcirculatory protection during percutaneous coronary intervention in acute ST-segment elevation myocardial infarction: a randomized controlled trial, JAMA 2005;293:1063-72. ▶ Even though this randomised trial involving patients with acute myocardial infarction, with and without ST segment elevation, failed to reveal improvement in reperfusion or reduction in myocardial injury to a perceptible extent in all the patients treated with distal protection, a subgroup of patients, presenting within 6 h from the onset of pain, had a significant benefit in terms of MACE from the use of a filter wire.
19. Rittersma SZ, van der Wal AC, Koch KT, et al. Plaque instability frequently occurs days or weeks before occlusive coronary thrombosis: a pathological thrombectomy study in primary percutaneous coronary intervention. Circulation 2005;111:1160-5. ▶ Plaque destabilisation with rupture or erosion and thrombus formation is a dynamic process which starts even weeks before the symptomatic coronary occlusion. The pathological analysis of the intracoronary thrombi, aspirated during angioplasty in patients with acute ST elevation myocardial infarction, were days or weeks old, indicating that sudden coronary occlusion is often preceded by a variable period of plaque instability and thrombus formation, initiated days or weeks before onset of symptoms.
20. Mizote I, Ueda Y, Ohtani T, et al. Distal protection improved reperfusion and reduced left ventricular dysfunction in patients with acute myocardial infarction who had angioscopically defined ruptured plaque. Circulation 2005;112:1001-7. ▶ The results of this study provide evidence that protection devices are able to reduce distal embolisation and consequent microvascular occlusion, avoiding a larger ischaemic injury and preventing left ventricular dysfunction in patients with acute myocardial infarction caused by plaque rupture.