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We have come to recognise that atherosclerosis is a highly dynamic process in the vascular wall, which not only involves lipid deposition and calcification, but also inflammation and both cell proliferation and apoptotic cell death. We have also come to recognise that atherosclerosis is not confined to conduit arteries but extends into the microcirculation. Finally, we have come to recognise that plaque rupture with complete thrombotic occlusion of an epicardial coronary artery, with subsequent acute myocardial infarction, may represent only the tip of the iceberg; moreover, repetitive, minor, and possibly subclinical plaque fissuring with embolisation of plaque material into the microcirculation may in fact be a frequent event, which occurs both spontaneously and during coronary interventions. Clinical consequences of coronary microembolisation range from acute, severe arrhythmias to chronic heart failure.
The editors of Heart have kindly provided us with this mini-symposium forum to highlight coronary microembolisation and its consequences, and thus increase the awareness of this phenomenon.