The role of MGuard stent in primary coronary angioplasty.

In a significant proportion of percutaneous coronary interventions (PCI) performed in the setting of acute myocardial infarction, despite apparently adequate restoration of blood flow in the target epicardial vessel, optimal myocardial reperfusion at tissue level is not achieved. This phenomenon, defined as no-reflow, has been consistently associated with negative outcomes; it involves many pathogenetic factors, including microvascular dysfunction and embolization of thrombus and plaque debris from the culprit lesion during PCI, particularly during stent deployment. Several strategies - either pharmacological or mechanical - have been developed in order to prevent or reduce the incidence of no-reflow, but this phenomenon still remains a major issue in primary coronary intervention. The MGuard stent is a relatively new device intended to ameliorate tissue reperfusion by reducing distal embolization: it consists of a balloon-expandable, bare metal stent platform, whose outer surface is covered by a mesh of polyethylene terephthalate (PET), so that after expansion the thrombus is entrapped between the stent struts and the vessel wall. This stent has been tested in lesions with a high embolic risk, as on vein grafts or in the setting of acute coronary syndromes. In this paper, we will review and discuss the data available about this device, with a particular focus on its use in primary PCI.