title: Prediction of distal embolization during percutaneous coronary intervention in saphenous vein grafts.
abstract: Distal protection devices have been proved to decrease distal embolization and improve outcome in unselected patients undergoing percutaneous coronary intervention (PCI) in saphenous vein grafts (SVGs). However, it remains uncertain whether distal protection is necessary in all patients. We investigated whether clinical or angiographic variables can predict distal embolization and, hence, need for a distal protection device. Fifty-eight consecutive SVGs that underwent PCI with a FilterWire distal protection device were studied. After the procedure, the FilterWire was fixed in formalin and photographed, and embolic debris area (square millimeters) was quantified by semi-automated edge-detection analysis. Debris area was correlated with 6 prespecified variables: clinical presentation, SVG age, reference lumen diameter, plaque volume, SVG degeneracy, and presence of a filling defect. Embolic debris was identified in 57 of 58 grafts (98%). Median debris area was 4.0 mm(2) (range 0.0 to 25.1). None of the prespecified variables predicted the occurrence of distal embolization or the amount of captured embolic debris. In conclusion, distal embolization during SVG PCI is universal. Embolic burden cannot be predicted by clinical or angiographic variables, and embolic protection should be used in all patients.
authors.affiliation: Department of Cardiology, John Radcliffe Hospital, Oxford, UK. bill.vangaal@conted.ox.ac.uk
authors.forename: William Joseph
authors.initials: WJ
authors.lastname: van Gaal
authors.forename: Robin Patrick
authors.initials: RP
authors.lastname: Choudhury
authors.forename: Italo
authors.initials: I
authors.lastname: Porto
authors.forename: Keith
authors.initials: K
authors.lastname: Channon
authors.forename: Adrian
authors.initials: A
authors.lastname: Banning
authors.forename: Vladimir
authors.initials: V
authors.lastname: Dzavik
authors.forename: Rachael
authors.initials: R
authors.lastname: Ramsamujh
authors.forename: Sanh
authors.initials: S
authors.lastname: Bui
authors.forename: Daniel James
authors.initials: DJ
authors.lastname: Blackman
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D004617:Embolism / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006440:Hemofiltration / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D011237:Predictive Value of Tests; D011859:Radiography; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000637:transplantation*