Embolic Protection With Filtering or Occlusion Balloons During Saphenous Vein Graft Stenting Retrieves Identical Volumes and Sizes of Particulate Debris

Abstract

Background-Distal embolization of plaque particulate liberated during stenting may cause periprocedural complications.The number, size, and volume of debris released during stenting, however, have not been quantified, rendering embolic protection approaches empiric. We used a novel method of microparticle size assessment to measure volume and characterize individual sizes of particles captured by the PercuSurge GuardWire balloon or a vascular filter during saphenous vein graft stenting. Methods and Results-Braided nitinol filters (average distal pore size 100 m) were used in 47 saphenous vein grafts in 44 patients. The PercuSurge GuardWire was used in 17 saphenous vein grafts in 16 patients. Particulate debris was subjected to microparticle size analysis (RapidVue, Beckman Coulter). All samples contained particulate debris. For both filter and GuardWire populations, most particles were Ͻ100 m in longest dimension (87% and 90% of particles, respectively), and the distribution of particle sizes was identical. Total embolic load per lesion for both filters and GuardWire aspirates was also similar: median embolic load per filter was 16 mm 3 (range 2 to 84 mm 3 ). Median embolic load per GuardWire was also 16 mm 3 (range 7 to 42 mm 3 ). Histopathologic analysis demonstrated that most samples contained plaque elements and platelet-rich thrombus. Conclusions-During saphenous vein graft interventions, particulate retrieved with a vascular filtering device or an occlusion balloon was similar in amount and character. This supports the notion that unless soluble mediators play an important role in adverse acute clinical events after stenting, the clinical efficacy of filtering devices may be equal to that of occlusion devices.

Novel Sirolimus–Coated Balloon Catheter

“…Furthermore, the animal model does not reflect the by far larger and hence more relevant distal embolization because of plaque debris (cholesterol, cholesterol esters, fragments of tissue, and extracellular matrix), which is unavoidable in percutaneous transluminal coronary angioplasty, transluminal peripheral angioplasty, and stent implantation. 36 The strongest inhibition of vessel narrowing was seen with the PCB. This finding compares well with previous preclinical studies investigating sirolimus-eluting stents and bare-metal stents mounted on PCBs.…”

Observation of the embolus protection filter for carotid artery stenting

“…Regarding with debris analysis, Rogers et al (14) and Hill et al (7) reported the volume and sized of particulate debris which were retrieved during saphenous vein graft stenting or CAS. They analyzed debris using microparticle analyzer and found that most particle were < 100 μm.…”

Volume and Composition of Emboli in Neuroprotected Stenting of the Carotid Artery

“…[15][16][17] Nevertheless, embolization of microparticles through pores with a medium size of 100 m is a major drawback commonly detected by intraprocedural transcranial Doppler sonography or as new-onset focal ischemic lesions on DWI after CAS. [5][6][7][8][9][10][11][18][19][20] Some evidence suggests that mostly the size of particles relates to the occurrence of periprocedural symptomatic neurologic events [21][22][23][24] and that the brain demonstrates a good tolerance for ischemia caused by these emboli.…”