PCI Complications: Distal Embolization

Page: PCI Complications: Distal Embolization

Editor(s)-In-Chief: C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org]; Alexandra Almonacid, M.D. [mailto:aalmonacid@partners.org]; Jeffrey J. Popma, M.D. [mailto:jpopma@partners.org]

Definition
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.

Incidence
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 SVG lesions, particularly those with recent occlusion.

Air Embolus

 * Often from manifold injections (contrast or flush); increase risk with pressurized flush
 * Small amount well tolerated; larger amount causes air-lock
 * Treatment: 100% O2, Narcotics, Suction vs hemopump, and Verapamil