State-of-the-Art Paper
Distal Myocardial Protection During Percutaneous Coronary Intervention: When and Where?

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The discrepancy between angiographic success and microvascular perfusion has been recognized for some time. In the face of an open artery, the degree of microvascular perfusion determines post-infarct prognosis. Despite successful epicardial recanalization, tissue perfusion may be absent in up to 25% patients with acute myocardial infarction. Historically associated with saphenous vein graft intervention, embolization is increasingly recognized in native coronary arteries, particularly in patients undergoing primary percutaneous coronary intervention (PCI). With more than two million PCI procedures performed worldwide each year, there is enormous interest in protecting the left ventricular myocardium from embolization during PCI. This article reviews the evidence for distal myocardial protection and discusses the relative merits of the different available techniques.

Abbreviations and Acronyms

AMI
acute myocardial infarction
ACS
acute coronary syndromes
CAPTIVE
CardioShield Application Protects During Transluminal Intervention of Vein Grafts by Reducing Emboli
CAS
carotid artery stenting
DPD
distal protection device
GP
glycoprotein
MACE
major adverse cardiac event
MBG
myocardial blush grade
MMP9
matrix metalloproteinase 9
PCI
percutaneous coronary intervention
PRIDE
PRotection During Saphenous Vein Graft Intervention to Prevent Distal Embolization
SAFE
Saphenous Vein Graft Angioplasty Free of Emboli trial
SAFER
Saphenous Vein Graft Angioplasty Free of Emboli Randomized trial
SVG
saphenous vein graft

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