Distal embolization (DE) of atherothrombotic debris into the coronary microcirculation occurs both in stable
and unstable coronary syndromes. Despite the well recognized clinical significance of periprocedural myocardial infarction
(MI) in stable percutaneous coronary intervention (PCI), the impact of DE has a much higher prognostic impact in the
acute setting, and especially in ST-elevation myocardial infarction, where DE is a main determinant of no-reflow phenomenon.
The present review aims to describe the pathophysiology of DE and to summarize the currently available pharmacological
strategies to prevent and treat DE in the setting of MI, especially focusing on antithrombotic, antiinflammatory
and vasodilator agents.