ABSTRACT
PROXIMAL EMBOLIC PROTECTION Several devices are designed to evacuate the intracoronary atheromatous and/or thrombotic debris or to prevent distal embolization. The Proxis system (St. Jude Medical, St. Paul, MN; Fig. 1) is indicated for use in the prevention of distal release of emboli in coronary vessels during a percutaneous coronary intervention (PCI). It is a unique device of combined proximal embolic protection and thrombus aspiration. The Proxis system is a single-operator full-length flexible catheter (6F or 7F guiding catheter compatible) and based on a carbon dioxide gas (CO2) inflation system. The inner diameter (ID) of the 6F Proxis system is 0.051 in (1.30 mm). The ID of the 7F Proxis system is 0.059 in (1.50 mm). It is deployed proximal to the target lesion before crossing. To allow for sufficient antegrade flow around the Proxis catheter, lesion and vessel size recommendations for Proxis placement are a “landing zone” of generally >10-12 mm proximal to the target lesion and a native vessel size ≥2.5 mm and a left main vessel ≥3.0 mm. Inflation of the sealing balloon suspends antegrade flow during the period of lesion intervention. Stagnated blood and emboli liberated during intervention could be retrieved by gentle aspiration. Crossing of the target lesion with the wire, balloon dilatation, and stent placement could be performed through the Proxis system and carried out under full proximal blockade of the vessel (1). Particularly in case of a coronary occlusion, it is recommended that the wire is not advanced through the target lesion at time of positioning the Proxis system to avoid any risk of embolization from crossing the target lesion with the wire. Aspiration and embolic protection by temporary proximal vessel occlusion could be repeated during each step of PCI.
