Contemporary use of embolic protection devices in saphenous vein graft interventions: Insights from the stenting of saphenous vein grafts trial

Neeraj Badhey, Christopher Lichtenwalter, James A de Lemos, Michele Roesle, Owen Obel, Tayo A Addo, Donald Haagen, Abdul Rahman Abdel-Karim, Bilal Saeed, Joseph K. Bissett, Rajesh Sachdeva, Vassilios V. Voudris, Panagiotis Karyofillis, Biswajit Kar, James Rossen, Panayotis Fasseas, Peter B. Berger, Subhash Banerjee, Emmanouil S Brilakis

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

Background: We sought to evaluate the contemporary use of embolic protection devices (EPDs) in saphenous vein graft (SVG) interventions. Methods: We examined EPD use in the stenting of saphenous vein grafts (SOS) trial, in which 80 patients with 112 lesions in 88 SVGs were randomized to a bare metal stent (39 patients, 43 grafts, and 55 lesions) or paclitaxel-eluting stent (41 patients, 45 grafts, and 57 lesions). Results: An EPD was used in 60 of 112 lesions (54%). A Filterwire (Boston Scientific) was used in 70% of EPD-treated lesions, Spider (ev3, Plymouth, Minnesota) in 12%, Proxis (St. Jude, Minneapolis, Minnesota) in 12%, and Guardwire (Medtronic, Santa Rosa, California) in 7%. Of the remaining 52 lesions, an EPD was not utilized in 13 lesions (25%) because the lesion was near the distal anastomosis, in 14 lesions (27%) because of an ostial location, in one lesion (2%) because of small SVG size, in two instent restenosis lesions (4%) because of low distal embolization risk, and in 22 lesions (42%) because of operator's preference even though use of an EPD was feasible. Procedural success was achieved in 77 patients (96%); in one patient a Filterwire was entrapped requiring emergency coronary bypass graft surgery and two patients had acute stent thrombosis. Conclusion: In spite of their proven efficacy, EPDs were utilized in approximately half of SVG interventions in the SOS trial. Availability of a proximal protection device could allow protection of ∼25% of unprotected lesions, yet operator discretion appears to be the major determinant of EPD use.

Original languageEnglish (US)
Pages (from-to)263-269
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume76
Issue number2
DOIs
StatePublished - Aug 1 2010

Keywords

  • Bypass grafts-coronary
  • Devices
  • Percutaneous coronary intervention
  • Thrombus

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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