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Contemporary use of embolic protection devices in saphenous vein graft interventions: Insights from the stenting of saphenous vein grafts trial
Journal article   Peer reviewed

Contemporary use of embolic protection devices in saphenous vein graft interventions: Insights from the stenting of saphenous vein grafts trial

Neeraj Badhey, Christopher Lichtenwalter, James A de Lemos, Michele Roesle, Owen Obel, Tayo A Addo, Donald Haagen, Abdul-Rahman Abdel-Karim, Bilal Saeed, Joseph K Bissett, …
Catheterization and cardiovascular interventions, Vol.76(2), pp.263-269
08/01/2010
DOI: 10.1002/ccd.22438
PMID: 20665875

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Abstract

We sought to evaluate the contemporary use of embolic protection devices (EPDs) in saphenous vein graft (SVG) interventions. We examined EPD use in the stenting of saphenous vein grafts (SOS) trial, in which 80 patients with 112 lesions in 88 SVGs were randomized to a bare metal stent (39 patients, 43 grafts, and 55 lesions) or paclitaxel-eluting stent (41 patients, 45 grafts, and 57 lesions). An EPD was used in 60 of 112 lesions (54%). A Filterwire (Boston Scientific) was used in 70% of EPD-treated lesions, Spider (ev3, Plymouth, Minnesota) in 12%, Proxis (St. Jude, Minneapolis, Minnesota) in 12%, and Guardwire (Medtronic, Santa Rosa, California) in 7%. Of the remaining 52 lesions, an EPD was not utilized in 13 lesions (25%) because the lesion was near the distal anastomosis, in 14 lesions (27%) because of an ostial location, in one lesion (2%) because of small SVG size, in two in-stent restenosis lesions (4%) because of low distal embolization risk, and in 22 lesions (42%) because of operator's preference even though use of an EPD was feasible. Procedural success was achieved in 77 patients (96%); in one patient a Filterwire was entrapped requiring emergency coronary bypass graft surgery and two patients had acute stent thrombosis. In spite of their proven efficacy, EPDs were utilized in approximately half of SVG interventions in the SOS trial. Availability of a proximal protection device could allow protection of approximately 25% of unprotected lesions, yet operator discretion appears to be the major determinant of EPD use.
 Single-Blind Method Drug-Eluting Stents Angioplasty, Balloon, Coronary - instrumentation Embolism - prevention & control Graft Occlusion, Vascular - diagnostic imaging Saphenous Vein - transplantation United States Humans Metals Middle Aged Graft Occlusion, Vascular - therapy Male Treatment Outcome Prosthesis Design Angioplasty, Balloon, Coronary - adverse effects Coronary Angiography Coronary Artery Bypass - adverse effects Graft Occlusion, Vascular - etiology Saphenous Vein - diagnostic imaging Aged Embolism - etiology Stents

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