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(Circulation. 2004;109:803-804.)
© 2004 American Heart Association, Inc.

Images in Cardiovascular Medicine

Debris Trapped by a Distal Protection Device May Mimic No-Reflow During Percutaneous Coronary Intervention

Robin P. Choudhury, DM, MRCP; Italo Porto, MD; Adrian P. Banning, MD, MRCP, FESC

From the Department of Cardiovascular Medicine (R.P.C.), University of Oxford, United Kingdom; Department of Cardiology (I.P., A.P.B.), John Radcliffe Hospital, Oxford, United Kingdom; and Università Cattolica del Sacro Cuore (I.P.), Rome, Italy.

Correspondence to Dr A.P. Banning, Department of Cardiology, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom. E-mail adrian.banning@orh.nhs.uk

An extract of the first 250 words of the full text is provided, because this article has no abstract.

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 3.5x12-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.

View larger version (48K): [in this window] [in a new window]   Figure 1. Right coronary arteriography; left anterior oblique projection. A, The right coronary artery was proximally occluded at the start of the procedure. B, After FilterWire deployment and direct stenting of the culprit lesion, there was angiographic no-reflow, with a filling defect (black arrow) within the open device (white arrow). C, Normal (TIMI grade 3) flow returned immediately after device withdrawal.

View larger version (33K): [in this window] [in a new window]   Figure 2. . . . [Full Text of this Article]