Distal embolization prevention during angioplasty ofsaphenous vein grafts

pp 102-108

Abstract

Background: Percutaneous treatment of degenerate saphenous vein grafts(SVG) is associated with a very high incidence of ischemiccomplications, leading to an increased morbidity and mor-tality risk in spite of the generalized use of stents and ag-gressive antiplatelet treatment.

Objective: We report our initial experience with a new distal emboliza-tion prevention device in the treatment of degenerated SVG.

Research Design and Methods: We included patients with new or reestenotic SVG lesions,which had an angiographically ≥ 60% stenotic diameter,≥ 3.5 - ≤ 5.5 mm distal reference diameter and an ostial-body graft location at least 30 mm proximal to the distal anastomosis to allow for the deployment of the filter. The EPI Filter Wire (EFW ®) system consists of a multiperforated basket (80 μm pores) mounted on a 0.014" guide wire placed distally to the target lesion through a 3.9 F delivery-retrieval sheath, designed as to capture embolic atheromatous debris during the procedure.

Results: We prospectively included 16 consecutive patients with severely degenerated SVG lesions. Clinical data included un-stable angina (n=13) or AMI (n = 3). Patients’ age was67.3±6.1 years, time since bypass surgery was 11.0±4.7years, lesion length 22.4±9.0 mm, stenotic diameter81.2±8.5%, reference vessel diameter 3.8± 0.5 mm. Fifty four percent of patients showed angiographic signs of thrombosis and IIb-IIIa inhibitors were used in 23% of them. I none patient the lesion was predilated and in another the lesion was passed over by means of a buddy-wire. The lesions could not be traversed with the EFW ® in 3 patients (2 of them with AMI). In all cases, a stent was implanted (mean length 27.1 mm), without predilatation in 8 patients. FinalTIMI3 flow was reached in all cases. One of 12 patients with unstable angina presented CK > 3x elevation during hospitalization. There were no mechanical complications or hemodynamic instability due to device utilization. In 3 patients’ histopathologic analysis of extracted material showed thrombotic and atherosclerotic debris.ConclusionsThe EPI Filter Wire ® utilization is feasible and is an encouraging method for prevention of distal embolization during the percutaneous treatment of degenerated saphenous vein grafts.