To defer, or not to defer, that is the question

EuroIntervention 2017;13:381-382. DOI: 10.4244/EIJV13I4A58

Henning Kelbæk
Henning Kelbæk1*, MD, DMSc; Dan Eik Høfsten2, MD, PhD; Thomas Engstrøm2, MD, PhD, DMSc
1. Department of Cardiology, Zealand University Hospital, Roskilde, Denmark; 2. Department of Cardiology, University of Copenhagen, Copenhagen, Denmark

Acute restoration of myocardial flow during primary percutaneous coronary intervention (PCI) is pivotal to the treatment of patients with ST-segment elevation myocardial infarction (STEMI). However, reperfusion injury and reduction of nutritional flow may occur despite successful re-opening and stent implantation in the infarct-related culprit lesion, and therefore an apparently normal epicardial flow may not reflect an adequate flow at the microvascular level. Thus, infarct extension may occur without visually observed flow reduction (no-reflow) or distal embolisation, and attempts to protect the peripheral vascular bed by thrombus aspiration or distal protection to avoid these complications have not been convincing.


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