Figure 2: Mechanisms and consequences of “spontaneous” and “procedural” distal embolisation in stable coronary artery disease and in acute coronary syndrome. In spontaneous distal embolisation, occurring only in ACS patients, dislodgement of atherothrombotic debris contributes to enlargement of the area of myocardial injury and microvascular obstruction consequent to epicardial coronary occlusion. This damage is further increased by debris shower during revascularization procedure (procedural distal embolisation). In stable coronary artery disease only procedural distal embolisation occurs, causing patchy microinfarcts.