e470 Manipulation of atherosclerotic lesions with wires, cath-eters, balloons, stents, and other intravascular devices during invasive procedures releases atherosclerotic plaque, resulting in distal embolization. This plaque debris leads to no or slow flow as a result of a multitude of factors, includ-ing mechanical obstruction of macrovascular and microvascu-lar channels, local platelet adhesion, platelet activation, and thrombosis attributable to release of tissue factors and micro-vascular spasm by release of thromboxane. The clinical mani-festation of this shower of atherosclerotic debris depends on the characteristics: the amount of debris, the size of particles, and the sensitivity of the organ perfused. Distal embolization during percutaneous coronary intervention (PCI) results in decreased distal perfusion, leading to myocardial ischemia or infarction. Manipulation of the aortic arch during coronary

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