Guiding catheter aspiration to prevent embolic events during saphenous vein graft intervention

Percutaneous coronary interventions (PCI) in saphenous vein graft (SVG) stenosis carries 10%-20% risk of major adverse clinical events (MACE) or reduced antigrade flow (No-reflow Phenomena). The PercuSurge device is not available at all United States hospitals and sometimes anatomically cannot be placed (distal stenosis). We developed a simple technique for use in patients who could not have the PercuSurge device placed during PCI of SVG.

The basic concept of this technique is the use of guiding catheter aspiration during PCI. Over a two-year period, seven patients underwent PCI in SVG, using this technique for symptomatic stenosis. They were all males, average SVG age was 14 +/- 6 years, 43% were degenerated SVG's, four (57%) had new stents placed, and three (43%) had percutaneous transluminal coronary angioplasty (PTCA) or cutting balloon therapy. All patients were pretreated with aspirin and clopidogrel and had baseline preprocedure serum creatine kinase (CK) and ECG. Following the procedure, patients had repeat serum CK and ECG eights hours post-procedure. No patients received glycoprotein platelets inhibitors.

Twenty to 60 mL of blood with gross macroscopic material was recovered during aspiration. None of the patients experienced no-reflow phenomena or had major elevated CKs during the procedure as defined as 5 x normal baseline. Thirty-day MACE in all patients was zero.

The pilot study suggests that guiding catheter aspiration may be effective in reducing MACE is some patients undergoing PCA in SVG.