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Prediction of distal embolization during percutaneous coronary intervention in saphenous vein grafts

William Joseph van Gaal1, Robin Patrick Choudhury, Italo Porto

  • 1Department of Cardiology, John Radcliffe Hospital, Oxford, UK. bill.vangaal@conted.ox.ac.uk

The American Journal of Cardiology
|February 24, 2007
PubMed

Insights

Distal protection devices are crucial during percutaneous coronary intervention (PCI) in saphenous vein grafts (SVGs). Embolic debris is universal, and its presence cannot be predicted by patient or graft characteristics, necessitating device use in all cases.

Area of Science:

  • Cardiovascular Interventions
  • Interventional Cardiology
  • Medical Device Technology

Background:

  • Distal protection devices reduce embolization and improve outcomes in percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs).
  • The necessity of distal protection in all SVG PCI patients remains unclear.
  • Predictors for distal embolization in SVG PCI require investigation.

Purpose of the Study:

  • To determine if clinical or angiographic variables can predict distal embolization during SVG PCI.
  • To assess the need for distal protection devices in all SVG PCI procedures.

Main Methods:

  • Fifty-eight consecutive SVG PCI procedures using a FilterWire distal protection device were analyzed.
  • Embolic debris captured by the FilterWire was quantified.
  • Debris area was correlated with clinical presentation, SVG age, lumen diameter, plaque volume, SVG degeneracy, and filling defects.

Main Results:

  • Embolic debris was detected in 98% of the analyzed SVG PCI procedures.
  • The median debris area was 4.0 mm².
  • No clinical or angiographic variables reliably predicted the occurrence or amount of distal embolization.

Conclusions:

  • Distal embolization is a universal event during SVG PCI.
  • Clinical and angiographic factors do not predict embolic burden.
  • Embolic protection devices should be routinely used in all SVG PCI procedures.

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