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Review Paper

Monitoring the Sequelae of Coronary Microembolization on Myocardium Using Noninvasive Imaging (Review)

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DOI: 10.4236/wjcd.2014.412073    3,694 Downloads   4,017 Views   Citations


Acute myocardial infarction (AMI) is a leading cause of death worldwide. It has been clinically classified into 1) ischemic from a primary coronary event (e.g., plaque rupture or thrombotic occlusion), 2) ischemic from a supply-and-demand mismatch and c) ischemic from a percutaneous coronary interventions (PCI). Catheter-based PCI has been frequently used as an alternative to conventional bypass surgery for patients at high risk. However, this method of treatment is associated with microvascular obstruction (MVO) by dislodged microemboli that results in left ventricular (LV) dysfunction/remodeling, perfusion deficits, microinfarction and arrhythmia. The contributions of microemboli after revascularization of AMI have been acknowledged by major cardiac and interventional societies. Recent studies showed that Emboli Detection and Classification (EDAC) Quantifier offers increased sensitivity and capability for detecting dislodged coronary microemboli during PCI. Coronary microembolization can be detected directly by monitoring intra-myocardial contrast opacification on contrast echocardiography, increasing F-18 fluorodeoxyglucose (FDG) uptake on positron emission tomography, loss/diminution of signal on first pass perfusion and hypoenhanced zone on contrast enhanced magnetic resonance imaging (MRI) and multidetector computed tomography (MDCT) and indirectly by ST-segment elevation on electro-cardiography (ECG). The relations between volumes/sizes of microemboli, visibility of microinfarct, myocardial perfusion and LV function are still under intensive discussions. Non-invasive imaging can play important role in assessing these parameters. This review shed the light on the techniques used for detecting coronary microemboli, microvascular obstruction and microinfarct and the short- and long-term effects of microemboli on LV function, structure and perfusion.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Saeed, M. and Wilson, M. (2014) Monitoring the Sequelae of Coronary Microembolization on Myocardium Using Noninvasive Imaging (Review). World Journal of Cardiovascular Diseases, 4, 601-622. doi: 10.4236/wjcd.2014.412073.


[1] Go, A.S., Mozaffarian, D., Roger, V.L., et al. (2013) Heart Disease and Stroke Statistics—2013 Update: A Report from the American Heart Association. Circulation, 127, e6-e245.
[2] Khan, J.N., Razvi, N., Nazir, S.A., et al. (2014) Prevalence and Extent of Infarct and Microvascular Obstruction Following Different Reperfusion Therapies in ST-Elevation Myocardial Infarction. Journal of Cardiovascular Magnetic Resonance, 16, 38.
[3] Caraballo, V. (1997) Fatal Myocardial Infarction Resulting from Coronary Artery Septic Embolism after Abortion: Unusual Cause and Complication of Endocarditis. Annals of Emergency Medicine, 29, 175-177.
[4] Charles, R.G., Epstein, E.J., Holt, S. and Coulshed, N. (1982) Coronary Embolism in Valvular Heart Disease. Quarterly Journal of Medicine, 51, 147-161.
[5] Garg, R.K. and Jolly, N. (2007) Acute Myocardial Infarction Secondary to Thromboembolism in a Patient with Atrial Fibrillation. International Journal of Cardiology, 123, e18-e20.
[6] Kitts, D., Bongard, F.S. and Klein, S.R. (1991) Septic Embolism Complicating Infective Endocarditis. Journal of Vascular Surgery, 14, 480-485.
[7] Quinn, E.G. and Fergusson, D.J. (1998) Coronary Embolism Following Aortic and Mitral Valve Replacement: Successful Management with Abciximab and Urokinase. Catheterization and Cardiovascular Diagnosis, 43, 457-459.<457::AID-CCD24>3.0.CO;2-F
[8] Takenaka, T., Horimoto, M., Igarashi, K., Yoshie, H., Tsujino, I. and Morihira, M. (1996) Multiple Coronary Thromboemboli Complicating Valvular Heart Disease and Atrial Fibrillation. American Heart Journal, 131, 194-196.
[9] Yutani, C., Imakita, M., Ueda-Ishibashi, H., Katsuragi, M. and Fujita, H. (1992) Coronary Artery Embolism with Special Reference to Invasive Procedures as the Source. Modern Pathology, 5, 244-249.
[10] Erbel, R. (2003) Spontaneous and Interventional Coronary Microembolisation. Heart, 89, 986-989.
[11] Mandell, B.F. (1987) Cardiovascular Involvement in Systemic Lupus Erythematosus. Seminars in Arthritis and Rheumatism, 17, 126-141.
[12] Westwood, M.A., Shah, F., Anderson, L.J., et al. (2007) Myocardial Tissue Characterization and the Role of Chronic Anemia in Sickle Cell Cardiomyopathy. Journal of Magnetic Resonance Imaging, 26, 564-568.
[13] Steg, P.G., James, S.K., Atar, D., et al. (2012) ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting with ST-Segment Elevation. European Heart Journal, 33, 2569-2619.
[14] Anderson, J.L., Adams, C.D., Antman, E.M., et al. (2007) ACC/AHA 2007 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. Journal of the American College of Cardiology, 50, e1-e157.
[15] Porto, I., Selvanayagam, J.B., Van Gaal, W.J., et al. (2006) Plaque Volume and Occurrence and Location of Periprocedural Myocardial Necrosis after Percutaneous Coronary Intervention: Insights from Delayed-Enhancement Magnetic Resonance Imaging, Thrombolysis in Myocardial Infarction Myocardial Perfusion Grade Analysis, and Intravascular Ultrasound. Circulation, 114, 662-669.
[16] Falk, E. (1985) Unstable Angina with Fatal Outcome: Dynamic Coronary Thrombosis Leading to Infarction and/or Sudden Death. Autopsy Evidence of Recurrent Mural Thrombosis with Peripheral Embolization Culminating in Total Vascular Occlusion. Circulation, 71, 699-708.
[17] Selvanayagam, J.B., Cheng, A.S., Jerosch-Herold, M., et al. (2007) Effect of Distal Embolization on Myocardial Perfusion Reserve after Percutaneous Coronary Intervention: A Quantitative Magnetic Resonance Perfusion Study. Circulation, 116, 1458-1464.
[18] Skyschally, A., Schulz, R., Erbel, R. and Heusch, G. (2002) Reduced Coronary and Inotropic Reserves with Coronary Microembolization. American Journal of Physiology-Heart and Circulatory Physiology, 282, H611-H614.
[19] Skyschally, A., Leineweber, K., Gres, P., Haude, M., Erbel, R. and Heusch, G. (2006) Coronary Microembolization. Basic Research in Cardiology, 101, 373-382.
[20] Erbel, R. and Heusch, G. (2000) Coronary Microembolization. Journal of the American College of Cardiology, 36, 22- 24.
[21] Davies, M.J. and Thomas, A.C. (1985) Plaque Fissuring—The Cause of Acute Myocardial Infarction, Sudden Ischaemic Death, and Crescendo Angina. British Heart Journal, 53, 363-373.
[22] Davies, M.J., Thomas, A.C., Knapman, P.A. and Hangartner, J.R. (1986) Intramyocardial Platelet Aggregation in Patients with Unstable Angina Suffering Sudden Ischemic Cardiac Death. Circulation, 73, 418-427.
[23] Okamura, A., Ito, H., Iwakura, K., et al. (2007) Detection and Quantification of Embolic Particles during Percutaneous Coronary Intervention to Stable Plaque: It Correlates to Coronary Flow Dynamics and Myocardial Damage. Catheterization and Cardiovascular Interventions, 69, 425-431.
[24] Kleinbongard, P., Bose, D., Baars, T., et al. (2011) Vasoconstrictor Potential of Coronary Aspirate from Patients Undergoing Stenting of Saphenous Vein Aortocoronary Bypass Grafts and Its Pharmacological Attenuation. Circulation Research, 108, 344-352.
[25] Beltrami, C.A., Finato, N., Rocco, M., et al. (1994) Structural Basis of End-Stage Failure in Ischemic Cardiomyopathy in Humans. Circulation, 89, 151-163.
[26] Klein, C., Nekolla, S.G., Bengel, F.M., et al. (2002) Assessment of Myocardial Viability with Contrast-Enhanced Magnetic Resonance Imaging: Comparison with Positron Emission Tomography. Circulation, 105, 162-167.
[27] Anderson, R.E. (2000) How Many Deaths Are Due to Medical Errors? JAMA, 284, 2187.
[28] Antoniucci, D., Valenti, R., Migliorini, A., et al. (2003) Comparison of Impact of Emergency Percutaneous Revascularization on Outcome of Patients > or =75 to Those <75 Years of Age with Acute Myocardial Infarction Complicated by Cardiogenic Shock. The American Journal of Cardiology, 91, 1458-1461.
[29] Bolognese, L., Carrabba, N., Parodi, G., et al. (2004) Impact of Microvascular Dysfunction on Left Ventricular Remodeling and Long-Term Clinical Outcome after Primary Coronary Angioplasty for Acute Myocardial Infarction. Circulation, 109, 1121-1126.
[30] Bolognese, L., Carrabba, N., Santoro, G.M., Valenti, R., Buonamici, P. and Antoniucci, D. (2003) Angiographic Findings, Time Course of Regional and Global Left Ventricular Function, and Clinical Outcome in Diabetic Patients with Acute Myocardial Infarction Treated with Primary Percutaneous Transluminal Coronary Angioplasty. The American Journal of Cardiology, 91, 544-549.
[31] Hardoff, R., Shefer, A., Gips, S., et al. (1990) Predicting Late Restenosis after Coronary Angioplasty by Very Early (12 to 24 h) Thallium-201 Scintigraphy: Implications with Regard to Mechanisms of Late Coronary Restenosis. Journal of the American College of Cardiology, 15, 1486-1492.
[32] Jain, A., Mahmarian, J.J., Borges-Neto, S., et al. (1988) Clinical Significance of Perfusion Defects by Thallium-201 Single Photon Emission Tomography Following Oral Dipyridamole Early after Coronary Angioplasty. Journal of the American College of Cardiology, 11, 970-976.
[33] Wijns, W., Serruys, P.W., Reiber, J.H., et al. (1985) Early Detection of Restenosis after Successful Percutaneous Transluminal Coronary Angioplasty by Exercise-Redistribution Thallium Scintigraphy. The American Journal of Cardiology, 55, 357-361.
[34] Wijns, W.W. and Serruys, P.W. (1985) Coronary Angioplasty in Myocardial Infarction. The American Journal of Cardiology, 56, 1004.
[35] Bachmann, R., Sechtem, U., Voth, E., Schroder, J., Hopp, H.W. and Schicha, H. (1997) Dipyridamole Scintigraphy and Intravascular Ultrasound after Successful Coronary Intervention. The Journal of Nuclear Medicine, 38, 553-558.
[36] Holmes Jr., D.R. (1990) Very Early Prediction of Restenosis after Successful Coronary Angioplasty: How Early Is Early and Can We Identify It? Journal of the American College of Cardiology, 15, 265-266.
[37] Rodes-Cabau, J., Candell-Riera, J., Domingo, E., et al. (2001) Frequency and Clinical Significance of Myocardial Ischemia Detected Early after Coronary Stent Implantation. The Journal of Nuclear Medicine, 42, 1768-1772.
[38] Jaffe, R., Haim, S.B., Karkabi, B., et al. (2002) Myocardial Perfusion Abnormalities Early (12 - 24 h) after Coronary Stenting or Balloon Angioplasty: Implications Regarding Pathophysiology and Late Clinical Outcome. Cardiology, 98, 60-66.
[39] Nagaoka, H., Iizuka, T., Kubota, S., et al. (1998) Redistribution in Thallium-201 Myocardial Imaging Soon after Successful Coronary Stenting—Tomographic Evaluation during Coronary Hyperemia Induced by Adenosine. Japanese Circulation Journal, 62, 160-166.
[40] Niccoli, G., Burzotta, F., Galiuto, L. and Crea, F. (2009) Myocardial No-Reflow in Humans. Journal of the American College of Cardiology, 54, 281-292.
[41] Heusch, G., Kleinbongard, P., Bose, D., et al. (2009) Coronary Microembolization: From Bedside to Bench and Back to Bedside. Circulation, 120, 1822-1836.
[42] Barrabes, J.A., Garcia-Dorado, D., Mirabet, M., et al. (2005) Antagonism of Selectin Function Attenuates Microvascular Platelet Deposition and Platelet-Mediated Myocardial Injury after Transient Ischemia. Journal of the American College of Cardiology, 45, 293-299.
[43] Ambrosio, G., Weisman, H.F., Mannisi, J.A. and Becker, L.C. (1989) Progressive Impairment of Regional Myocardial Perfusion after Initial Restoration of Postischemic Blood Flow. Circulation, 80, 1846-1861.
[44] Jaffe, R., Dick, A. and Strauss, B.H. (2010) Prevention and Treatment of Microvascular Obstruction-Related Myocardial Injury and Coronary No-Reflow Following Percutaneous Coronary Intervention: A Systematic Approach. JACC: Cardiovascular Interventions, 3, 695-704.
[45] Monassier, J.P. (2008) Reperfusion Injury in Acute Myocardial Infarction: From Bench to Cath Lab. Part II: Clinical Issues and Therapeutic Options. Archives of Cardiovascular Diseases, 101, 565-575.
[46] Niccoli, G., Cosentino, N., Spaziani, C., Minelli, S., Fracassi, F. and Crea, F. (2011) New Strategies for the Management of No-Reflow after Primary Percutaneous Coronary Intervention. Expert Review of Cardiovascular Therapy, 9, 615-630.
[47] Porto, I., Biasucci, L.M., De Maria, G.L., et al. (2012) Intracoronary Microparticles and Microvascular Obstruction in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Intervention. European Heart Journal, 33, 2928-2938.
[48] Califf, R.M., Abdelmeguid, A.E., Kuntz, R.E., et al. (1998) Myonecrosis after Revascularization Procedures. Journal of the American College of Cardiology, 31, 241-251.
[49] Herrmann, J. (2005) Peri-Procedural Myocardial Injury: 2005 Update. European Heart Journal, 26, 2493-2519.
[50] Chia, S., Senatore, F., Raffel, O.C., Lee, H., Wackers, F.J. and Jang, I.K. (2008) Utility of Cardiac Biomarkers in Predicting Infarct Size, Left Ventricular Function, and Clinical Outcome after Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction. JACC: Cardiovascular Interventions, 1, 415-423.
[51] Hallen, J., Buser, P., Schwitter, J., et al. (2009) Relation of Cardiac Troponin I Measurements at 24 and 48 Hours to Magnetic Resonance-Determined Infarct Size in Patients with ST-Elevation Myocardial Infarction. The American Journal of Cardiology, 104, 1472-1477.
[52] Giannitsis, E., Steen, H., Kurz, K., et al. (2008) Cardiac Magnetic Resonance Imaging Study for Quantification of Infarct Size Comparing Directly Serial versus Single Time-Point Measurements of Cardiac Troponin T. Journal of the American College of Cardiology, 51, 307-314.
[53] Saeed, M., Hetts, S.W., Do, L. and Wilson, M.W. (2013) MRI Study on Volume Effects of Coronary Emboli on Myocardial Function, Perfusion and Viability. International Journal of Cardiology, 165, 93-99.
[54] Saeed, M., Hetts, S.W., Do, L. and Wilson, M.W. (2013) Coronary Microemboli Effects in Preexisting Acute Infarcts in a Swine Model: Cardiac MR Imaging Indices, Injury Biomarkers, and Histopathologic Assessment. Radiology, 268, 98-108.
[55] Mehran, R., Dangas, G., Mintz, G.S., et al. (2000) Treatment of In-Stent Restenosis with Excimer Laser Coronary Angioplasty versus Rotational Atherectomy: Comparative Mechanisms and Results. Circulation, 101, 2484-2489.
[56] Kong, T.Q., Davidson, C.J., Meyers, S.N., Tauke, J.T., Parker, M.A. and Bonow, R.O. (1997) Prognostic Implication of Creatine Kinase Elevation Following Elective Coronary Artery Interventions. JAMA, 277, 461-466.
[57] Migliorini, A., Stabile, A., Rodriguez, A.E., et al. (2010) Comparison of AngioJet Rheolytic Thrombectomy before Direct Infarct Artery Stenting with Direct Stenting Alone in Patients with Acute Myocardial Infarction. The JETSTENT Trial. Journal of the American College of Cardiology, 56, 1298-1306.
[58] Kunadian, B., Dunning, J., Vijayalakshmi, K., Thornley, A.R. and de Belder, M.A. (2007) Meta-Analysis of Randomized Trials Comparing Anti-Embolic Devices with Standard PCI for Improving Myocardial Reperfusion in Patients with Acute Myocardial Infarction. Catheterization and Cardiovascular Interventions, 69, 488-496.
[59] Jacquier, A., Revel, D. and Saeed, M. (2008) MDCT of the Myocardium: A New Contribution to Ischemic Heart Disease. Academic Radiology, 15, 477-487.
[60] Okamura, A., Ito, H., Iwakura, K., et al. (2005) Detection of Embolic Particles with the Doppler Guide Wire during Coronary Intervention in Patients with Acute Myocardial Infarction: Efficacy of Distal Protection Device. Journal of the American College of Cardiology, 45, 212-215.
[61] Schwartz, R.S., Burke, A., Farb, A., et al. (2009) Microemboli and Microvascular Obstruction in Acute Coronary Thrombosis and Sudden Coronary Death: Relation to Epicardial Plaque Histopathology. Journal of the American College of Cardiology, 54, 2167-2173.
[62] De Maria, G.L., Patel, N., Kassimis, G. and Banning, A.P. (2013) Spontaneous and Procedural Plaque Embolisation in Native Coronary Arteries: Pathophysiology, Diagnosis, and Prevention. Scientifica (Cairo), 2013, Article ID: 364247.
[63] Falk, E. (1991) Coronary Thrombosis: Pathogenesis and Clinical Manifestations. The American Journal of Cardiology, 68, 28B-35B.
[64] Furie, B. and Furie, B.C. (2008) Mechanisms of Thrombus Formation. The New England Journal of Medicine, 359, 938-949.
[65] Bose, D., von Birgelen, C., Zhou, X.Y., et al. (2008) Impact of Atherosclerotic Plaque Composition on Coronary Microembolization during Percutaneous Coronary Interventions. Basic Research in Cardiology, 103, 587-597.
[66] Hong, Y.J., Mintz, G.S., Kim, S.W., et al. (2009) Impact of Plaque Composition on Cardiac Troponin Elevation after Percutaneous Coronary Intervention: An Ultrasound Analysis. JACC: Cardiovascular Imaging, 2, 458-468.
[67] Uetani, T., Amano, T., Ando, H., et al. (2008) The Correlation between Lipid Volume in the Target Lesion, Measured by Integrated Backscatter Intravascular Ultrasound, and Post-Procedural Myocardial Infarction in Patients with Elective Stent Implantation. European Heart Journal, 29, 1714-1720.
[68] Gu, Y., Bai, Y., Wu, J., Hu, L. and Gao, B. (2010) Establishment and Characterization of an Experimental Model of Coronary Thrombotic Microembolism in Rats. The American Journal of Pathology, 177, 1122-1130.
[69] Dicks DL, Carlsson M, Heiberg E, et al. (2009) Persistent Decline in Longitudinal and Radial Strain after Coronary Microembolization Detected on Velocity Encoded Phase Contrast Magnetic Resonance Imaging. Journal of Magnetic Resonance Imaging, 30, 69-76.
[70] Carlsson, M., Wilson, M., Martin, A.J. and Saeed, M. (2009) Myocardial Microinfarction after Coronary Microembolization in Swine: MR Imaging Characterization. Radiology, 250, 703-713.
[71] Carlsson, M., Saloner, D., Martin, A.J., Ursell, P.C. and Saeed, M. (2010) Heterogeneous Microinfarcts Caused by Coronary Microemboli: Evaluation with Multidetector CT and MR Imaging in a Swine Model. Radiology, 254, 718-728.
[72] Carlsson, M., Martin, A.J., Ursell, P.C., Saloner, D. and Saeed, M. (2009) Magnetic Resonance Imaging Quantification of Left Ventricular Dysfunction Following Coronary Microembolization. Magnetic Resonance in Medicine, 61, 595-602.
[73] Dorge, H., Neumann, T., Behrends, M., et al. (2000) Perfusion-Contraction Mismatch with Coronary Microvascular Obstruction: Role of Inflammation. American Journal of Physiology-Heart and Circulatory Physiology, 279, H2587-H2592.
[74] Angelini, A., Rubartelli, P., Mistrorigo, F., et al. (2004) Distal Protection with a Filter Device during Coronary Stenting in Patients with Stable and Unstable Angina. Circulation, 110, 515-521.
[75] Bahrmann, P., Figulla, H.R., Wagner, M., Ferrari, M., Voss, A. and Werner, G.S. (2005) Detection of Coronary Micro-embolisation by Doppler Ultrasound during Percutaneous Coronary Interventions. Heart, 91, 1186-1192.
[76] Bahrmann, P., Werner, G.S., Heusch, G., et al. (2007) Detection of Coronary Microembolization by Doppler Ultrasound in Patients with Stable Angina Pectoris Undergoing Elective Percutaneous Coronary Interventions. Circulation, 115, 600-608.
[77] DeMaria, A.N., Narula, J., Mahmud, E. and Tsimikas, S. (2006) Imaging Vulnerable Plaque by Ultrasound. Journal of the American College of Cardiology, 47, C32-C39.
[78] Fujii, K., Carlier, S.G., Mintz, G.S., et al. (2005) Association of Plaque Characterization by Intravascular Ultrasound Virtual Histology and Arterial Remodeling. The American Journal of Cardiology, 96, 1476-1483.
[79] Nair, A., Kuban, B.D., Tuzcu, E.M., Schoenhagen, P., Nissen, S.E. and Vince, D.G. (2002) Coronary Plaque Classification with Intravascular Ultrasound Radiofrequency Data Analysis. Circulation, 106, 2200-2206.
[80] Rodriguez-Granillo, G.A., Serruys, P.W., Garcia-Garcia, H.M., et al. (2006) Coronary Artery Remodelling Is Related to Plaque Composition. Heart, 92, 388-391.
[81] Vancraeynest, D., Pasquet, A., Roelants, V., Gerber, B.L. and Vanoverschelde, J.L. (2011) Imaging the Vulnerable Plaque. Journal of the American College of Cardiology, 57, 1961-1979.
[82] Freeman, M.R., Williams, A.E., Chisholm, R.J. and Armstrong, P.W. (1989) Intracoronary Thrombus and Complex Morphology in Unstable Angina. Relation to Timing of Angiography and In-Hospital Cardiac Events. Circulation, 80, 17-23.
[83] Kirma, C., Izgi, A., Dundar, C., et al. (2008) Clinical and Procedural Predictors of No-Reflow Phenomenon after Primary Percutaneous Coronary Interventions: Experience at a Single Center. Circulation Journal, 72, 716-721.
[84] Napodano, M., Pasquetto, G., Sacca, S., et al. (2003) Intracoronary Thrombectomy Improves Myocardial Reperfusion in Patients Undergoing Direct Angioplasty for Acute Myocardial Infarction. Journal of the American College of Cardiology, 42, 1395-1402.
[85] Zhao, X.Q., Theroux, P., Snapinn, S.M. and Sax, F.L. (1999) Intracoronary Thrombus and Platelet Glycoprotein IIb/IIIa Receptor Blockade with Tirofiban in Unstable Angina or Non-Q-Wave Myocardial Infarction. Angiographic Results from the PRISM-PLUS Trial (Platelet Receptor Inhibition for Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms). PRISM-PLUS Investigators. Circulation, 100, 1609-1615.
[86] Chechi, T., Vecchio, S., Vittori, G., et al. (2008) ST-Segment Elevation Myocardial Infarction Due to Early and Late Stent Thrombosis a New Group of High-Risk Patients. Journal of the American College of Cardiology, 51, 2396-2402.
[87] Carlsson, M., Osman, N.F., Ursell, P.C., Martin, A.J. and Saeed, M. (2008) Quantitative MR Measurements of Regional and Global Left Ventricular Function and Strain after Intramyocardial Transfer of VM202 into Infarcted Swine Myocardium. American Journal of Physiology-Heart and Circulatory Physiology, 295, H522-H532.
[88] Dicks, D., Saloner, D., Martin, A., Ursell, P., Carlsson, M. and Saeed, M. (2009) Cardiovascular Magnetic Resonance Imaging for Percutaneous Transendocardial Delivery and Three Dimensional Left Ventricular Strain Assessment of VEGF Gene Therapy in Occlusive Infarction. International Journal of Cardiology, 143, 255-263.
[89] Jacquier, A., Higgins, C.B., Martin, A.J., Do, L., Saloner, D. and Saeed, M. (2007) Injection of Adeno-Associated Viral Vector Encoding Vascular Endothelial Growth Factor Gene in Infarcted Swine Myocardium: MR Measurements of Left Ventricular Function and Strain. Radiology, 245, 196-205.
[90] Saeed, M., Martin, A., Jacquier, A., et al. (2008) Permanent Coronary Artery Occlusion: Cardiovascular MR Imaging Is Platform for Percutaneous Transendocardial Delivery and Assessment of Gene Therapy in Canine Model. Radiology, 249, 560-571.
[91] Saeed, M., Martin, A., Ursell, P., et al. (2008) MR assessment of Myocardial Perfusion, Viability, and Function after Intramyocardial Transfer of VM202, a New Plasmid Human Hepatocyte Growth Factor in Ischemic Swine Myocardium. Radiology, 249, 107-118.
[92] Saeed, M., Saloner, D., Martin, A., et al. (2007) Adeno-Associated Viral Vector-Encoding Vascular Endothelial Growth Factor Gene: Effect on Cardiovascular MR Perfusion and Infarct Resorption Measurements in Swine. Radiology, 243, 451-460.
[93] Saeed, M., Weber, O., Lee, R., et al. (2006) Discrimination of Myocardial Acute and Chronic (Scar) Infarctions on Delayed Contrast Enhanced Magnetic Resonance Imaging with Intravascular Magnetic Resonance Contrast Media. Journal of the American College of Cardiology, 48, 1961-1968.
[94] Saeed, M., Martin, A.J., Lee, R.J., et al. (2006) MR Guidance of Targeted Injections into Border and Core of Scarred Myocardium in Pigs. Radiology, 240, 419-426.
[95] Choi, J.W., Gibson, C.M., Murphy, S.A., Davidson, C.J., Kim, R.J. and Ricciardi, M.J. (2004) Myonecrosis Following Stent Placement: Association between Impaired TIMI Myocardial Perfusion Grade and MRI Visualization of Microinfarction. Catheterization and Cardiovascular Interventions, 61, 472-476.
[96] Ricciardi, M.J., Wu, E., Davidson, C.J., et al. (2001) Visualization of Discrete Microinfarction after Percutaneous Coronary Intervention Associated with Mild Creatine Kinase-MB Elevation. Circulation, 103, 2780-2783.
[97] Selvanayagam, J.B., Kardos, A., Nicolson, D., et al. (2004) Anteroseptal or Apical Myocardial Infarction: A Controversy Addressed Using Delayed Enhancement Cardiovascular Magnetic Resonance Imaging. Journal of Cardiovascular Magnetic Resonance, 6, 653-661.
[98] Selvanayagam, J.B., Petersen, S.E., Francis, J.M., et al. (2004) Effects of Off-Pump versus On-Pump Coronary Surgery on Reversible and Irreversible Myocardial Injury: A Randomized Trial Using Cardiovascular Magnetic Resonance Imaging and Biochemical Markers. Circulation, 109, 345-350.
[99] Saeed, M., Hetts, S., English, J., Do, L. and Wilson, M. (2011) Quantitative and Qualitative Characterization of the Acute Changes in Myocardial Structure and Function after Distal Coronary Microembolization Using MDCT. Academic Radiology, 18, 479-87.
[100] George, R.T., Jerosch-Herold, M., Silva, C., et al. (2007) Quantification of Myocardial Perfusion Using Dynamic 64-Detector Computed Tomography. Investigative Radiology, 42, 815-822.
[101] Galiuto, L. (2004) Optimal Therapeutic Strategies in the Setting of Post-Infarct No Reflow: The Need for a Pathogenetic Classification. Heart, 90, 123-125.
[102] Breuckmann, F., Nassenstein, K., Bucher, C., et al. (2009) Systematic Analysis of Functional and Structural Changes after Coronary Microembolization: A Cardiac Magnetic Resonance Imaging Study. JACC: Cardiovascular Imaging, 2, 121-130.
[103] Nassenstein, K., Breuckmann, F., Bucher, C., et al. (2008) How Much Myocardial Damage Is Necessary to Enable Detection of Focal Late Gadolinium Enhancement at Cardiac MR Imaging? Radiology, 249, 829-835.
[104] Saeed, M., Hetts, S.W., Do, L., Sullivan, S. and Wilson, M.W. (2012) MDCT Has the Potential to Predict Percutaneous Coronary Intervention Outcome in Swine Model: Microscopic Validation. Acta Radiologica, 53, 987-994.
[105] Saeed, M., Hetts, S.W., Ursell, P.C., Do, L., Kolli, K.P. and Wilson, M.W. (2012) Evaluation of the Acute Effects of Distal Coronary Microembolization Using Multidetector Computed Tomography and Magnetic Resonance Imaging. Magnetic Resonance in Medicine, 67, 1747-1757.
[106] Robbers, L.F., Delewi, R., Nijveldt, R., et al. (2013) Myocardial Infarct Heterogeneity Assessment by Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Imaging Shows Predictive Value for Ventricular Arrhythmia Development after Acute Myocardial Infarction. European Heart Journal-Cardiovascular Imaging, 14, 1150-1158.
[107] Yan, A.T., Shayne, A.J., Brown, K.A., et al. (2006) Characterization of the Peri-Infarct Zone by Contrast-Enhanced Cardiac Magnetic Resonance Imaging Is a Powerful Predictor of Post-Myocardial Infarction Mortality. Circulation, 114, 32-39.
[108] Kramer, C.M., Rogers, W.J., Park, C.S., et al. (1998) Regional Myocyte Hypertrophy Parallels Regional Myocardial Dysfunction during Post-Infarct Remodeling. Journal of Molecular and Cellular Cardiology, 30, 1773-1778.
[109] Uren, N.G., Crake, T., Lefroy, D.C., de Silva, R., Davies, G.J. and Maseri, A. (1994) Reduced Coronary Vasodilator Function in Infarcted and Normal Myocardium after Myocardial Infarction. The New England Journal of Medicine, 331, 222-227.
[110] Bogaert, J., Kalantzi, M., Rademakers, F.E., Dymarkowski, S. and Janssens, S. (2007) Determinants and Impact of Microvascular Obstruction in Successfully Reperfused ST-Segment Elevation Myocardial Infarction. Assessment by Magnetic Resonance Imaging. European Radiology, 17, 2572-2580.
[111] Inauen, W., Payne, D.K., Kvietys, P.R. and Granger, D.N. (1990) Hypoxia/Reoxygenation Increases the Permeability of Endothelial Cell Monolayers: Role of Oxygen Radicals. Free Radical Biology & Medicine, 9, 219-223.
[112] Choi, C.J., Haji-Momenian, S., Dimaria, J.M., et al. (2004) Infarct Involution and Improved Function during Healing of Acute Myocardial Infarction: The Role of Microvascular Obstruction. Journal of Cardiovascular Magnetic Resonance, 6, 917-925.
[113] Ingkanisorn, W.P., Rhoads, K.L., Aletras, A.H., Kellman, P. and Arai, A.E. (2004) Gadolinium Delayed Enhancement Cardiovascular Magnetic Resonance Correlates with Clinical Measures of Myocardial Infarction. Journal of the American College of Cardiology, 43, 2253-2259.
[114] Hombach, V., Grebe, O., Merkle, N., et al. (2005) Sequelae of Acute Myocardial Infarction Regarding Cardiac Structure and Function and Their Prognostic Significance as Assessed by Magnetic Resonance Imaging. European Heart Journal, 26, 549-557.
[115] Ibrahim, T., Hackl, T., Nekolla, S.G., et al. (2010) Acute Myocardial Infarction: Serial Cardiac MR Imaging Shows a Decrease in Delayed Enhancement of the Myocardium during the 1st Week after Reperfusion. Radiology, 254, 88-97.
[116] Mather, A.N., Fairbairn, T.A., Artis, N.J., Greenwood, J.P. and Plein, S. (2011) Timing of Cardiovascular MR Imaging after Acute Myocardial Infarction: Effect on Estimates of Infarct Characteristics and Prediction of Late Ventricular Remodeling. Radiology, 261, 116-126.
[117] Ghugre, N.R., Pop, M., Barry, J., Connelly, K.A. and Wright, G.A. (2013) Quantitative Magnetic Resonance Imaging Can Distinguish Remodeling Mechanisms after Acute Myocardial Infarction Based on the Severity of Ischemic Insult. Magnetic Resonance in Medicine, 70, 1095-1105.
[118] Bajwa, H.Z., Do, L., Suhail, M., Hetts, S.W., Wilson, M.W. and Saeed, M. (2014) MRI Demonstrates a Decrease in Myocardial Infarct Healing and Increase in Compensatory Ventricular Hypertrophy Following Mechanical Microvascular Obstruction. Journal of Magnetic Resonance Imaging, 40, 906-914.
[119] Kloner, R.A., Rude, R.E., Carlson, N., Maroko, P.R., DeBoer, L.W. and Braunwald, E. (1980) Ultrastructural Evidence of Microvascular Damage and Myocardial Cell Injury after Coronary Artery Occlusion: Which Comes First? Circulation, 62, 945-952.
[120] Wu, K.C., Zerhouni, E.A., Judd, R.M., et al. (1998) Prognostic Significance of Microvascular Obstruction by Magnetic Resonance Imaging in Patients with Acute Myocardial Infarction. Circulation, 97, 765-772.
[121] Klem, I., Shah, D.J., White, R.D., et al. (2011) Prognostic Value of Routine Cardiac Magnetic Resonance Assessment of Left Ventricular Ejection Fraction and Myocardial Damage: An International, Multicenter Study. Circulation: Cardiovascular Imaging, 4, 610-619.
[122] Wu, E., Ortiz, J.T., Tejedor, P., et al. (2008) Infarct Size by Contrast Enhanced Cardiac Magnetic Resonance Is a Stronger Predictor of Outcomes than Left Ventricular Ejection Fraction or End-Systolic Volume Index: Prospective Cohort Study. Heart, 94, 730-736.
[123] De Waha, S., Desch, S., Eitel, I., et al. (2010) Impact of Early vs. Late Microvascular Obstruction Assessed by Magnetic Resonance Imaging on Long-Term Outcome after ST-Elevation Myocardial Infarction: A Comparison with Traditional Prognostic Markers. European Heart Journal, 31, 2660-2668.
[124] Klug, G., Mayr, A., Schenk, S., et al. (2012) Prognostic Value at 5 Years of Microvascular Obstruction after Acute Myocardial Infarction Assessed by Cardiovascular Magnetic Resonance. Journal of Cardiovascular Magnetic Resonance, 14, 46.
[125] Rezkalla, S.H. and Kloner, R.A. (2008) Coronary No-Reflow Phenomenon: From the Experimental Laboratory to the Cardiac Catheterization Laboratory. Catheterization and Cardiovascular Interventions, 72, 950-957.
[126] Lund, G.K., Stork, A., Saeed, M., et al. (2004) Acute Myocardial Infarction: Evaluation with First-Pass Enhancement and Delayed Enhancement MR Imaging Compared with 201Tl SPECT Imaging. Radiology, 232, 49-57.
[127] Hori, M., Inoue, M., Kitakaze, M., et al. (1986) Role of Adenosine in Hyperemic Response of Coronary Blood Flow in Microembolization. American Journal of Physiology, 250, H509-H518.
[128] Dorge, H., Schulz, R., Belosjorow, S., et al. (2002) Coronary Microembolization: The Role of TNF-Alpha in Contractile Dysfunction. Journal of Molecular and Cellular Cardiology, 34, 51-62.
[129] Pfeffer, M.A., Pfeffer, J.M., Fishbein, M.C., et al. (1979) Myocardial Infarct Size and Ventricular Function in Rats. Circulation Research, 44, 503-512.
[130] Suhail, M.S., Wilson, M.W., Hetts, S.W. and Saeed, M. (2013) Magnetic Resonance Imaging Characterization of Circumferential and Longitudinal Strain under Various Coronary Interventions in Swine. World Journal of Radiology, 5, 472-483.
[131] Pfeffer, M.A. (1995) Left Ventricular Remodeling after Acute Myocardial Infarction. Annual Review of Medicine, 46, 455-466.
[132] Ingels Jr., N.B., Daughters 2nd, G.T., Stinson, E.B. and Alderman, E.L. (1975) Measurement of Midwall Myocardial Dynamics in Intact Man by Radiography of Surgically Implanted Markers. Circulation, 52, 859-867.
[133] Ingels Jr., NB., Daughters 2nd, G.T., Stinson, E.B. and Alderman, E.L. (1980) Evaluation of Methods for Quantitating Left Ventricular Segmental Wall Motion in Man Using Myocardial Markers as a Standard. Circulation, 61, 966-972.
[134] Ordovas, K.G., Carlsson, M., Lease, K.E., et al. (2012) Impaired Regional Left Ventricular Strain after Repair of Tetralogy of Fallot. Journal of Magnetic Resonance Imaging, 35, 79-85.
[135] Heusch, G., Schulz, R., Haude, M. and Erbel, R. (2004) Coronary Microembolization. Journal of Molecular and Cellular Cardiology, 37, 23-31.
[136] Skyschally, A., Gres, P., Hoffmann, S., et al. (2007) Bidirectional Role of Tumor Necrosis Factor-Alpha in Coronary Microembolization: Progressive Contractile Dysfunction versus Delayed Protection against Infarction. Circulation Research, 100, 140-146.
[137] Thielmann, M., Dorge, H., Martin, C., et al. (2002) Myocardial Dysfunction with Coronary Microembolization: Signal Transduction through a Sequence of Nitric Oxide, Tumor Necrosis Factor-Alpha, and Sphingosine. Circulation Research, 90, 807-813.
[138] Kotani, J., Mintz, G.S., Pregowski, J., et al. (2003) Volumetric Intravascular Ultrasound Evidence That Distal Embolization during Acute Infarct Intervention Contributes to Inadequate Myocardial Perfusion Grade. The American Journal of Cardiology, 92, 728-732.
[139] Fukuda, D., Tanaka, A., Shimada, K., Nishida, Y., Kawarabayashi, T. and Yoshikawa, J. (2003) Predicting Angiographic Distal Embolization Following Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction. The American Journal of Cardiology, 91, 403-407.
[140] Frink, R.J., Rooney Jr., P.A., Trowbridge, J.O. and Rose, J.P. (1988) Coronary Thrombosis and Platelet/Fibrin Microemboli in Death Associated with Acute Myocardial Infarction. British Heart Journal, 59, 196-200.
[141] Stone, G.W., Webb, J., Cox, D.A., et al. (2005) Distal Microcirculatory Protection during Percutaneous Coronary Intervention in Acute ST-Segment Elevation Myocardial Infarction: A Randomized Controlled Trial. JAMA, 293, 1063- 1072.
[142] Jung, C., Sorensson, P., Saleh, N., Arheden, H., Ryden, L. and Pernow, J. (2012) Circulating Endothelial and Platelet Derived Microparticles Reflect the Size of Myocardium at Risk in Patients with ST-elevation Myocardial Infarction. Atherosclerosis, 221, 226-231.
[143] Saber, R.S., Edwards, W.D., Bailey, K.R., McGovern, T.W., Schwartz, R.S. and Holmes Jr., D.R. (1993) Coronary Embolization after Balloon Angioplasty or Thrombolytic Therapy: An Autopsy Study of 32 Cases. Journal of the American College of Cardiology, 22, 1283-1288.
[144] Selvanayagam, J.B., Porto, I., Channon, K., et al. (2005) Troponin Elevation after Percutaneous Coronary Intervention Directly Represents the Extent of Irreversible Myocardial Injury: Insights from Cardiovascular Magnetic Resonance Imaging. Circulation, 111, 1027-1032.
[145] Selvangyagam, J.B., Rahimi, K., Banning, A., et al. (2008) Prognostic Significance of Post-Procedural Irreversible Myocardial Injury Detected by Cardiovascular Magnetic Resonance Imaging. Journal of Cardiovascular Magnetic Resonance, 10, A1.
[146] Kotani, J., Nanto, S., Mintz, G.S., et al. (2002) Plaque Gruel of Atheromatous Coronary Lesion May Contribute to the No-Reflow Phenomenon in Patients with Acute Coronary Syndrome. Circulation, 106, 1672-1677.
[147] Prati, F., Pawlowski, T., Gil, R., et al. (2003) Stenting of Culprit Lesions in Unstable Angina Leads to a Marked Reduction in Plaque Burden: A Major Role of Plaque Embolization? A Serial Intravascular Ultrasound Study. Circulation, 107, 2320-2325.
[148] Angioplasty Substudy Investigators (1997) A Clinical Trial Comparing Primary Coronary Angioplasty with Tissue Plasminogen Activator for Acute Myocardial Infarction. The Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO IIb) Angioplasty Substudy Investigators. The New England Journal of Medicine, 336, 1621-1628.
[149] Murakami, M., Iwasaki, K., Kusachi, S., et al. (2006) Nicorandil Reduces the Incidence of Minor Cardiac Marker Elevation after Coronary Stenting. International Journal of Cardiology, 107, 48-53.
[150] Erbel, R. and Heusch, G. (1999) Coronary Microembolization—Its Role in Acute Coronary Syndromes and Interventions. Herz, 24, 558-575.
[151] Erbel, R. and Heusch, G. (1999) Spontaneous and Iatrogenic Microembolization. A New Concept for the Pathogenesis of Coronary Artery Disease. Herz, 24, 493-495.
[152] Appelbaum, E. and Manning, W.J. (2009) Science to Practice: Can the Combination of Resting First-Pass Myocardial Perfusion and Late Gadolinium-Enhanced Cardiovascular MR Imaging Help Identify Myocardial Infarction Resulting from Coronary Microembolization? Radiology, 250, 609-611.
[153] Schmidt, A., Azevedo, C.F., Cheng, A., et al. (2007) Infarct Tissue Heterogeneity by Magnetic Resonance Imaging Identifies Enhanced Cardiac Arrhythmia Susceptibility in Patients with Left Ventricular Dysfunction. Circulation, 115, 2006-2014.
[154] Schuleri, K.H., Centola, M., George, R.T., et al. (2009) Characterization of Peri-Infarct Zone Heterogeneity by Contrast-Enhanced Multidetector Computed Tomography: A Comparison with Magnetic Resonance Imaging. Journal of the American College of Cardiology, 53, 1699-1707.
[155] de Bakker, J.M., van Capelle, F.J., Janse, M.J., et al. (1988) Reentry as a Cause of Ventricular Tachycardia in Patients with Chronic Ischemic Heart Disease: Electrophysiologic and Anatomic Correlation. Circulation, 77, 589-606.
[156] Srinivasan, M., Rihal, C., Holmes, D.R. and Prasad, A. (2009) Adjunctive Thrombectomy and Distal Protection in Primary Percutaneous Coronary Intervention: Impact on Microvascular Perfusion and Outcomes. Circulation, 119, 1311-1319.
[157] Grube, E., Gerckens, U., Yeung, A.C., et al. (2001) Prevention of Distal Embolization during Coronary Angioplasty in Saphenous Vein Grafts and Native Vessels Using Porous Filter Protection. Circulation, 104, 2436-2441.
[158] Haeck, J.D., Koch, K.T., Bilodeau, L., et al. (2009) Randomized Comparison of Primary Percutaneous Coronary Intervention with Combined Proximal Embolic Protection and Thrombus Aspiration versus Primary Percutaneous Coronary Intervention Alone in ST-Segment Elevation Myocardial Infarction: The PREPARE (PRoximal Embolic Protection in Acute Myocardial Infarction and Resolution of ST-Elevation) Study. JACC: Cardiovascular Interventions, 2, 934-943.
[159] Carlino, M., De Gregorio, J., Di Mario, C., et al. (1999) Prevention of Distal Embolization during Saphenous Vein Graft Lesion Angioplasty. Experience with a New Temporary Occlusion and Aspiration System. Circulation, 99, 3221-3223.
[160] Hamburger, J.N. and Serruys, P.W. (1997) Treatment of Thrombus Containing Lesions in Diseased Native Coronary Arteries and Saphenous Vein Bypass Grafts Using the AngioJet Rapid Thrombectomy System. Herz, 22, 318-321.
[161] Ischinger, T. (2001) Thrombectomy with the X-SIZER Catheter System in the Coronary Circulation: Initial Results from a Multi-Center Study. Journal of Invasive Cardiology, 13, 81-88.
[162] Patel, S. and Hermiller, J. (2008) Embolic Protection: The FilterWire EZTM Embolic Protection System. Expert Review of Medical Devices, 5, 19-24.
[163] Svilaas, T., Vlaar, P.J., van der Horst, I.C., et al. (2008) Thrombus Aspiration during Primary Percutaneous Coronary Intervention. The New England Journal of Medicine, 358, 557-567.
[164] Gick, M., Jander, N., Bestehorn, H.P., et al. (2005) Randomized Evaluation of the Effects of filter-Based Distal Protection on Myocardial Perfusion and Infarct Size after Primary Percutaneous Catheter Intervention in Myocardial Infarction with and without ST-Segment Elevation. Circulation, 112, 1462-1469.
[165] Junghans, U. and Siebler, M. (2003) Cerebral Microembolism Is Blocked by Tirofiban, a Selective Nonpeptide Platelet Glycoprotein IIb/IIIa Receptor Antagonist. Circulation, 107, 2717-2721.
[166] de Lemos, J.A., Gibson, C.M., Antman, E.M., et al. (2001) Abciximab and Early Adjunctive Percutaneous Coronary Intervention Are Associated with Improved ST-Segment Resolution after Thrombolysis: Observations from the TIMI 14 Trial. American Heart Journal, 141, 592-598.
[167] Kunichika, H., Ben-Yehuda, O., Lafitte, S., Kunichika, N., Peters, B. and DeMaria, A.N. (2004) Effects of Glycoprotein IIb/IIIa Inhibition on Microvascular Flow after Coronary Reperfusion: A Quantitative Myocardial Contrast Echocardiography Study. Journal of the American College of Cardiology, 43, 276-283.
[168] Yang, Y.J., Zhao, J.L., You, S.J., et al. (2006) Different Effects of Tirofiban and Aspirin plus Clopidogrel on Myocardial No-Reflow in a Mini-Swine Model of Acute Myocardial Infarction and Reperfusion. Heart, 92, 1131-1137.

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