Distal Protection During Percutaneous Coronary Intervention in Native Right Coronary Arteries

Liberation of plaque debris during PCI in native coronary arteries is supposed to be a possible mechanism of the no-reflow phenomenon, which can cause impairment of the distal and microvascular circulations. Therefore, ten consecutive patients undergoing PCI for complex lesions in their native right coronary arteries were enrolled in a pilot trial, using the triActiv system (Kensey Nash Company) for distal protection. For all patients, device success (device was successfully delivered to the target location, device operated as intended and was successfully retrieved) could be documented. For the primary (MACE rate at 30 days) and secondary endpoints no events were reported, neither in hospital nor during the follow-up period of 30 days. Debris was found in all patients in whom the extracted fluid could be investigated (7/10), the average particle size being 28 x 68 mu m. This observation suggests that embolization can occur during PCI of native coronary vessels and may be more often present than so far expected. Larger studies, however, are needed to confirm the relevance of this finding.