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

• Published in: Catheterization and cardiovascular interventions Vol. 76; no. 2; pp. 263 - 269
• Main Authors: 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.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.08.2010
• Subjects: Aged; Angioplasty, Balloon, Coronary - adverse effects; Angioplasty, Balloon, Coronary - instrumentation; bypass grafts-coronary; Coronary Angiography; Coronary Artery Bypass - adverse effects; devices; Drug-Eluting Stents; Embolism - etiology; Embolism - prevention & control; Graft Occlusion, Vascular - diagnostic imaging; Graft Occlusion, Vascular - etiology; Graft Occlusion, Vascular - therapy; Humans; Male; Metals; Middle Aged; percutaneous coronary intervention; Prosthesis Design; Saphenous Vein - diagnostic imaging; Saphenous Vein - transplantation; Single-Blind Method; Stents; thrombus; Treatment Outcome; United States
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.22438

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 in‐stent 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. © 2010 Wiley‐Liss, Inc.