PCI complications: distal embolization

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alexandra Almonacid, M.D. [2]; Jeffrey J. Popma, M.D. [3]

Overview

Clinical distal embolization during PCI is defined as the evidence of peri-procedural myonecrosis, while angiographic distal embolization is known as the migration of a filling defect or thrombus to distally occlude the target vessel or one of its branches.

Distal Embolization

Causes

• Often from manifold injections (contrast or flush); increase risk with pressurized flush
• Small amount well tolerated; larger amount causes air-lock

Epidemiology and Demograhics

Distal embolization occurs in approximately 10% of patients with an acute myocardial infarction undergoing PCI. Embolic complications occur more often in patients with acute MI and in patients undergoing balloon angioplasty of saphenous vein graft lesions, particularly those with recent occlusion.

Diagnosis

Coronary Angiography: Distal Embolization

Treatment

• 100% O2, Narcotics, Suction vs hemopump, and Verapamil