Spontaneous and Procedural Plaque Embolisation in Native Coronary Arteries: Pathophysiology, Diagnosis, and Prevention

Table 1

Main differences in pathophysiology, diagnosis, and prevention of spontaneous and procedural distal embolisation.

	Distal embolisation
	Spontaneous	Procedural
		Stable CAD	ACS
Clinical setting	ACS
Embolisate dimension	Macro- and microembolisation	Macro- and microembolisation
Embolisate composition	Atherothrombotic fragments; Platelets aggregates; Platelet-monocytes aggregates; Microthrombi; Microparticles; Cholesterol crystal; Amorphous material; Humoral factors	Atherosclerotic fragments; Hyaline material; Fibrous material; Cholesterol crystal	As in spontaneous; DE
Biochemical activity	↑↑↑	↑	↑↑↑
Diagnosis	True diagnosis only at postmortem analysis	Laboratory; ↑ Troponin ↑ CK MB; Imaging; MCE; CMR; Cath-Lab; TIMI flow	Laboratory; ↑ Troponin ↑ CK MB; Imaging; MCE; CMR; Cath-Lab; Intracoronary ECG; ST resolution; TIMI flow and cTFC; MBG
Therapy and prevention	Pharmacologic; Aspirin; Clopidogrel; Prasugrel/ticagrelor; GPIIb/IIIa inhibitors; Statin; Vasodilators  (adenosine/nitroprusside)	Pharmacologic; Aspirin; Clopidogrel; Statin; GPIIb/IIIa*; Vasodilators*	Pharmacologic; As in spontaneous; DE
	Mechanical; none	Mechanical (only in SVG); Distal protection; Balloon-based; Filter-based; Proximal protection	Mechanical; thrombectomy

∗Only in complicated PCI.
ACS: acute coronary syndrome; CAD: coronary artery disease; CMR: cardiac magnetic resonance; cTFC: corrected TIMI frame count; DE: distal embolisation; MCE: myocardial contrast echocardiography; MBG: myocardial blush grade; TF: tissue factor; TIMI: thrombolysis in myocardial infarction.