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 journalArticle

23 Citations (Scopus)

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

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Embolic Protection Devices
Saphenous Vein
Transplants
Stents
Spiders
Paclitaxel
Emergencies
Thrombosis
Metals

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Contemporary use of embolic protection devices in saphenous vein graft interventions : Insights from the stenting of saphenous vein grafts trial. / Badhey, Neeraj; Lichtenwalter, Christopher; de Lemos, James A; Roesle, Michele; Obel, Owen; Addo, Tayo A; Haagen, Donald; Abdel-Karim, Abdul Rahman; Saeed, Bilal; Bissett, Joseph K.; Sachdeva, Rajesh; Voudris, Vassilios V.; Karyofillis, Panagiotis; Kar, Biswajit; Rossen, James; Fasseas, Panayotis; Berger, Peter B.; Banerjee, Subhash; Brilakis, Emmanouil S.

In: Catheterization and Cardiovascular Interventions, Vol. 76, No. 2, 01.08.2010, p. 263-269.

Research output: Contribution to journalArticle

Badhey, N, Lichtenwalter, C, de Lemos, JA, Roesle, M, Obel, O, Addo, TA, Haagen, D, Abdel-Karim, AR, Saeed, B, Bissett, JK, Sachdeva, R, Voudris, VV, Karyofillis, P, Kar, B, Rossen, J, Fasseas, P, Berger, PB, Banerjee, S & Brilakis, ES 2010, 'Contemporary use of embolic protection devices in saphenous vein graft interventions: Insights from the stenting of saphenous vein grafts trial', Catheterization and Cardiovascular Interventions, vol. 76, no. 2, pp. 263-269. https://doi.org/10.1002/ccd.22438
Badhey, Neeraj ; Lichtenwalter, Christopher ; de Lemos, James A ; Roesle, Michele ; Obel, Owen ; Addo, Tayo A ; Haagen, Donald ; Abdel-Karim, Abdul Rahman ; Saeed, Bilal ; Bissett, Joseph K. ; Sachdeva, Rajesh ; Voudris, Vassilios V. ; Karyofillis, Panagiotis ; Kar, Biswajit ; Rossen, James ; Fasseas, Panayotis ; Berger, Peter B. ; Banerjee, Subhash ; Brilakis, Emmanouil S. / Contemporary use of embolic protection devices in saphenous vein graft interventions : Insights from the stenting of saphenous vein grafts trial. In: Catheterization and Cardiovascular Interventions. 2010 ; Vol. 76, No. 2. pp. 263-269.
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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.",
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AU - de Lemos, James A

AU - Roesle, Michele

AU - Obel, Owen

AU - Addo, Tayo A

AU - Haagen, Donald

AU - Abdel-Karim, Abdul Rahman

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N2 - 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.

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