Okamura Atsunori, Ito Hiroshi, Iwakura Katsuomi, Kawano Shigeo, Inoue Koichi, Maekawa Yoshihiro, Ogihara Toshio, Fujii Kenshi
Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan.
J Am Coll Cardiol. 2005 Jan 18;45(2):212-5. doi: 10.1016/j.jacc.2004.09.062.
We investigated whether embolic particles could be detected as high-intensity transient signals (HITS) with a Doppler guide wire during percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) We also assessed whether these signals could be reduced using a distal protection (DP) device.
Embolization of thrombi and plaque components to the microcirculation is a major complication of PCI in patients with AMI. Embolic particles running in the cerebral artery are detected as HITS by transcranial Doppler ultrasound.
We prospectively studied 16 consecutive patients with AMI who underwent direct PCI within 24 h after the onset of symptoms. A PercuSurge GuardWire (MedtronicAVE, Santa Rosa, California) was used as the DP device. Eight patients were randomly assigned to the non-DP group, and the remaining eight were assigned to the DP group. Coronary flow velocity was recorded continuously from before the first balloon inflation to after balloon deflation.
All patients in the non-DP group had HITS detected (12 +/- 9 counts) within five consecutive beats (4 +/- 1 beat) after balloon deflation, but none were detected in any of the patients in the DP group.
The Doppler guide wire can be used to visually detect and count emboli as HITS, and the DP device is effective for prevention of distal embolization.
我们研究了在急性心肌梗死（AMI）患者经皮冠状动脉介入治疗（PCI）期间，是否能用多普勒导丝将栓塞颗粒检测为高强度瞬态信号（HITS）。我们还评估了使用远端保护（DP）装置是否能减少这些信号。
血栓和斑块成分向微循环的栓塞是AMI患者PCI的主要并发症。经颅多普勒超声可将在脑动脉中流动的栓塞颗粒检测为HITS。
我们前瞻性地研究了16例症状发作后24小时内接受直接PCI的连续AMI患者。使用PercuSurge GuardWire（美敦力AVE，加利福尼亚州圣罗莎）作为DP装置。8例患者随机分配至非DP组，其余8例分配至DP组。从首次球囊扩张前至球囊放气后连续记录冠状动脉血流速度。
非DP组所有患者在球囊放气后的连续五个心动周期（4±1个心动周期）内均检测到HITS（12±9次计数），但DP组患者均未检测到。
多普勒导丝可用于直观地检测和计数作为HITS的栓子，DP装置对预防远端栓塞有效。
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