title: 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.
  
  
  RESULTS
  Braided nitinol filters (average distal pore size 100 microns) 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 <100 microm 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 mm3 (range 2 to 84 mm3). Median embolic load per GuardWire was also 16 mm3 (range 7 to 42 mm3). 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.
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, Mass 02115, USA. crogers@partners.org
authors.forename: Campbell
authors.initials: C
authors.lastname: Rogers
authors.forename: Rany
authors.initials: R
authors.lastname: Huynh
authors.forename: Philip A
authors.initials: PA
authors.lastname: Seifert
authors.forename: Bernard
authors.initials: B
authors.lastname: Chevalier
authors.forename: Joachim
authors.initials: J
authors.lastname: Schofer
authors.forename: Elazer R
authors.initials: ER
authors.lastname: Edelman
authors.forename: Gregory
authors.initials: G
authors.lastname: Toegel
authors.forename: Arun
authors.initials: A
authors.lastname: Kuchela
authors.forename: Amy
authors.initials: A
authors.lastname: Woupio
authors.forename: Richard E
authors.initials: RE
authors.lastname: Kuntz
authors.forename: Natalie D
authors.initials: ND
authors.lastname: Macon
mesh_terms: D000497:Alloys; D002138:Calibration; D002404:Catheterization; D001026:Coronary Artery Bypass / Q000295:instrumentation / Q000379:methods*; D003324:Coronary Artery Disease / Q000473:pathology / Q000601:surgery*; D004617:Embolism / Q000209:etiology / Q000517:prevention & control*; D004867:Equipment Design; D005374:Filtration / Q000295:instrumentation; D005487:Foam Cells / Q000648:ultrastructure; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control*; D008863:Microspheres; D010316:Particle Size; D016032:Randomized Controlled Trials as Topic; D012501:Saphenous Vein / Q000637:transplantation; D015607:Stents; D013396:Suction; D013927:Thrombosis / Q000473:pathology
chemical_list: D000497:Alloys; C013616:nitinol