Debris Trapped by a Distal Protection Device May Mimic No-Reflow During Percutaneous Coronary Intervention
A 64-year-old woman presented to our hospital with chest pain and ST-segment elevation in the inferior leads. After successful thrombolysis with tissue plasminogen activator, chest pain and ST-segment elevation recurred. She was transferred to the cardiac catheterization laboratory, where a significant stenosis in the left anterior descending coronary artery (not shown) and proximal right coronary artery occlusion were demonstrated (Figure 1A). The occlusion was crossed easily with a 0.014-in guidewire. A FilterWire protection device (EPI, Boston Scientific) was deployed to reduce the risk of distal embolization. The lesion was direct stented with two 3.5×12-mm Express 2 stents without predilatation. However, chest pain and ST segment elevation persisted, and antegrade flow was markedly diminished (Thrombolysis in Myocardial Infarction [TIMI] grade 1) (Figure 1B). Removal of the FilterWire resulted in immediate normalization of flow (Figure 1C). On inspection, the filter device contained a large amount of debris (Figure 2). We conclude that angiographic no-reflow can be mimicked when a distal capture device is full of embolic material. The patient recovered well with only minimal residual inferior hypokinesis on echocardiography.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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