Prevention of Distal Embolization During Coronary Angioplasty in Saphenous Vein Grafts and Native Vessels Using Porous Filter Protection

Abstract

Background-Although distal embolization and the "no-reflow" phenomenon are well described in saphenous vein graft (SVG) interventions, the frequency, magnitude, and characterization of embolized debris have not been evaluated in routine coronary interventions. A unique embolus protection device described herein provides a means of containing and retrieving plaque material dislodged during percutaneous coronary interventions. This report details the first clinical experience of the effectiveness and safety of an emboli protection system in 11 SVG lesions and 15 native coronary artery lesions. Methods and Results-The AngioGuard Emboli Capture Guidewire (Cordis) consists of a PTCA wire with an expandable filter at the distal tip. The porous membrane permits normal distal blood flow, while trapping potential emboli by filtration. After crossing the lesion, the filter is expanded, and routine angioplasty is performed over the same wire. Emboli retrieval is achieved by collapsing the filter and retracting the emboli capture wire (ECW). In 26 patients, standard angioplasty was performed over the ECW; 20 of these 26 patients received a stent. Collected debris was sent for histopathological analysis. Plaque debris was retrieved after native coronary and SVG interventions in all cases. The ECW was positioned and retrieved without complications. No major adverse events occurred. Myocardial infarctions and no-reflow were not observed. Conclusions-The embolization of plaque fragments frequently occurs during coronary and SVG intervention. Distal embolization leading to microvascular obstruction and no-reflow could be successfully minimized by using the ECW.

Lack of Benefit From Intravenous Platelet Glycoprotein IIb/IIIa Receptor Inhibition as Adjunctive Treatment for Percutaneous Interventions of Aortocoronary Bypass Grafts

“…22 A recent study, performed on a small group of patients, demonstrated that using an emboli protection filter device, plaque debris could be retrieved in all of the interventions performed, both in the native circulation and in vein grafts. 23 In our analysis, patients undergoing PCI of a graft had an almost 2-fold increase in MI at 30 days compared with those treated for native disease. The likely explanation for the lack of efficacy associated with adjunctive IIb/IIIa integrin blockade is that the amount or the composition of the material embolized during PCI of bypass graft lesions may overwhelm the capacity of these agents to protect the distal vasculature.…”

Utilization of a Double-Wire Technique to Treat Long Extended Spiral Dissection of the Right Coronary Artery: Evaluation of Incidence and Mechanisms

“…Due to the continuous development of new devices, [8][9][10][11][12] technical refinements, 11,12) and increasing operator experience, the TRA approach has become one of the most popular methods for either diagnostic cardiac catheterization or PCI in the real world. This is because the TRA approach can provide several additional benefits in comparison to the traditional femoral arterial approach, including less discomfort during and after the procedure, less bleeding and vascular complications, shorter hospitalization, ability to perform the procedure in outpatient departments without difficulty, and the ability of the patient to walk immediately following the procedure.…”

“…This study investigated the incidence, potential risk, and clinical outcomes of extensive dissection of the RCA, and clarified the strategic management for such patients. 9,000 patients who underwent diagnostic cardiac catheterization simultaneously developed antegrade and retrograde dissection of the RCA. Moreover, it was found that 14 (0.39%) of 3,600 patients who underwent PCI developed simultaneous antegrade and retrograde dissection of the RCA.…”

Histopathological Findings of the No-reflow Phenomenon Following Coronary Intervention for Acute Coronary Syndrome

“…Moreover, previous reports suggested that the pathogenesis of the no-reflow phenomenon after PCI to an atherosclerotic coronary artery may differ from the no-reflow phenomenon obtained using animal models in which a normal coronary artery was occluded, as the importance of microembolization has been recognized in atherosclerotic vascular disease. [7][8][9] Saber, et al 10) reported that coronary microembolization was observed in patients following angioplasty or thrombolytic therapy in an autopsy study. However, they did not mention whether these patients had no-reflow phenomenon or not.…”