Prevention of coronary slow flow/no reflow during percutaneous coronary intervention by the use of embolic protection de
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CASE REPORT
Prevention of coronary slow flow/no reflow during percutaneous coronary intervention by the use of embolic protection device, ‘Filtrap’ Kohichiro Iwasaki • Takeshi Matsumoto • Hitoshi Aono • Hiroshi Furukawa • Masanobu Samukawa
Received: 15 September 2009 / Accepted: 13 November 2009 / Published online: 25 December 2009 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2009
Abstract A 68 year-old man underwent percutaneous coronary intervention (PCI). A 64 multi-slice computed tomography (MSCT) demonstrated a non-calcified plaque with positive remodeling. Intravascular ultrasound showed severe attenuation which suggested high risk of coronary no reflow during PCI. In order to avoid this, we used an embolic protection device, Filtrap. Immediately after deployment of a Taxus stent, ST-elevation with chest pain and coronary no reflow appeared. After retrieval of the Filtrap device, ST-elevation and no reflow disappeared. The filter was filled with yellow materials. This case suggests two things: that 64 MSCT can detect coronary plaque with high-risk of coronary no reflow during PCI; and that using a Filtrap device can effectively prevent the coronary no reflow during PCI. Keywords Percutaneous coronary intervention Coronary slow flow/no reflow Embolic protection device
Introduction Percutaneous coronary intervention (PCI) has become a well established technique. However, over time, it has been recognized that distal embolization of particulate matter, including plaque and thrombus, at the time of balloon inflation or stent deployment, may complicate PCI which in turn may lead to periprocedural morbidity. Devising ways
K. Iwasaki (&) T. Matsumoto H. Aono H. Furukawa M. Samukawa Department of Cardiology, Okayama Central Hospital, 6-3 Ishimakitamachi, Okayama, Japan e-mail: [email protected]
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of reducing this distal embolization using a variety of mechanical means are currently being developed. This case study demonstrates that the use of an embolic protection device, ‘Filtrap’, effectively prevented coronary slow flow/no reflow during PCI. A 68 year-old man was referred to our hospital for 64 multi-slice computed tomography (MSCT). Over a period of 3 weeks he had felt chest pain whilst walking in the morning. He had a history of hypertension, diabetes mellitus, and hyperlipidemia and was currently taking medication. An electrocardiograph was normal. A 64 MSCT scan demonstrated a non-calcified plaque with positive remodeling in the proximal portion of the right coronary artery (Fig. 1). The mean CT density of the plaque was 51 Hounsfield units. These findings suggested vulnerable plaque. A week later he underwent coronary angiography, under the diagnosis of stable effort angina, which demonstrated 90% stenosis in the same portion of the right coronary artery (Fig. 2a). Thus, he underwent PCI 2 weeks later. Because the 64 MSCT findings suggested vulnerable plaque, we performed coronary angioplasty with 2.0 mm balloon and thereafter performed an intravascular ultras
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