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Preventing Distal Embolization of Coils After Therapeutic Graft Closure: The CRISP Technique
Glen Aprile1, Adam B Iqbal1, Gregor Leibundgut2
1Department of Cardiology, Royal Jubilee Hospital, Victoria, British Columbia, Canada.
Insights
Graft failure after bypass surgery is common. A new technique, the CRushed In situ Stent Plug (CRISP), uses a crushed stent to secure coils, preventing dangerous distal embolization during graft closure.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Biomedical Engineering
Background:
- Coronary artery bypass grafting (CABG) frequently leads to graft failure.
- Native vessel intervention is recommended post-graft failure.
- Competitive flow from patent grafts can compromise native vessel intervention durability.
Observation:
- Therapeutic graft closure is often necessary after successful native vessel intervention.
- Coil embolization is a recognized complication of graft closure.
- Graft disease or tortuosity can aid stable coil deployment, but patent grafts pose a risk.
Findings:
- A novel technique, the CRushed In situ Stent Plug (CRISP), is proposed.
- CRISP involves strategically deploying and partially crushing a stent within the graft body.
- This acts as a plug to secure coils, preventing distal embolization.
Implications:
- The CRISP technique offers a solution for managing patent grafts during closure.
- It aims to improve the safety and efficacy of graft closure procedures.
- This innovation may enhance the durability of native vessel interventions following CABG.
Abstract:
Patients with coronary artery bypass surgery will invariably experience graft failure. In this setting, treatment of the native vessel is recommended. After successful native vessel intervention, competitive flow from a patent graft may limit the durability of native vessel intervention, and thus therapeutic graft closure is usually recommended. Graft closure is frequently achieved with coils, but a recognized complication with coils is distal embolization during or after deployment. The presence of disease or tortuosity in grafts may allow stable deployment of coils and prevent this. However, with relatively patent grafts, it may be difficult to deploy coils without a risk of embolization. To overcome this problem, we propose a new technique where we strategically deploy and fashion a partially crushed stent in the body of the graft to serve as a plug to hold coils and prevent distal embolization, called the CRISP (CRushed In situ Stent Plug) technique.
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