Edo Kaluski, M.D., NJ Medical School & University Hospital, Newark, NJ, USA
Distal embolization (DE) occurs in practically all cases of primary PCI. However, DE has been noted angiographically and clinically in only 15% and 35% of primary PCI respectively and is associated with poor clinical outcome and higher mortality. DE is composed of predominantly organized clot (47%), fresh thrombus (29%) and atherosclerotic debris (24%). Most major embolization events occur during stent deployment. Hence it is suggested that DE modalities should be present during stenting and should be protective against all DE material. In the review of current devices that are used to reduce DE burden it appears that most devices (with the exception of MGuard) do not effectively deal with most potential embolic debris and are not present during stenting. The future of DE protection devices will be determined by ongoing randomized clinical trials.