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Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
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Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg

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Real world single center experience with saphenous vein grafts interventions: should filters be filtered out?

Adman Kassier1, Ronak Soni, Kameel Kassab

  • 1Ascension Borgess Hospital, Michigan State University and Western Michigan University, 1521 Gull Rd, GOC 327, Kalamazoo, MI 49048. Adnan.kassier@gmail.com.

The Journal of Invasive Cardiology
|September 28, 2023
PubMed

Insights

The Borgess protocol, using intracoronary nicardipine and direct stenting, offers a promising alternative to embolic protection devices for saphenous vein graft interventions, showing favorable outcomes and reduced major adverse cardiovascular events.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Saphenous vein graft (SVG) percutaneous coronary intervention (PCI) faces challenges like no-reflow and myocardial injury due to distal embolization and vasoconstriction.
  • Current guidelines recommend embolic protection devices (EPDs) for SVG PCI, but their effectiveness has been suboptimal in many studies.
  • The Borgess protocol, involving prophylactic intracoronary nicardipine and direct stenting, is presented as an alternative to EPDs.

Purpose of the Study:

  • To evaluate the efficacy and safety of the Borgess protocol as an alternative to EPDs in saphenous vein graft interventions.
  • To assess the rate of major adverse cardiovascular events (MACE) following SVG interventions using the Borgess protocol.

Main Methods:

  • A retrospective cohort study of 424 consecutive SVG interventions performed between 2017 and 2021.
  • The primary outcome was 30-day MACE, defined as death, emergent coronary artery bypass graft surgery, myocardial infarction, or target vessel revascularization.
  • Data on adherence to the Borgess protocol and use of intracoronary nicardipine were collected.

Main Results:

  • The study included 424 SVG interventions, with 76% presenting with acute coronary syndrome.
  • The Borgess protocol was fully adhered to in 36% of cases, and intracoronary nicardipine was used in 72%.
  • The 30-day MACE rate was 3.5%, primarily driven by myocardial infarction (2.6%).

Conclusions:

  • The Borgess protocol demonstrated favorable outcomes in SVG interventions compared to SVG PCI strategies using EPDs.
  • This approach may offer a viable alternative for managing complex SVG interventions.
  • Further research is warranted, acknowledging the limitations of this single-center, retrospective study.
Abstract

Keywords:
distal embolic protectionfilter wirenicardipinepercutaneous coronary interventionnsaphenous vein grafts

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