Distal embolization during native vessel and vein graft coronary intervention with a vascular protection device: predictors of high-risk lesions.
OBJECTIVE
We sought to define clinical and angiographic variables that may predict patients and lesions at increased risk for distal embolism during percutaneous intervention (PCI), as assessed by debris retrieval from a distal-protection filter device.


BACKGROUND
Distal thrombo- and atheroembolism may contribute to periprocedural myocardial necrosis during PCI, which may in turn affect long-term outcomes. Distal protection devices have been used to reduce this occurrence with variable outcomes depending on lesion and patient subsets.


METHODS
194 consecutive patients in whom the FilterWire(R) device (FW) [Boston Scientific Corp., Natick, MA] was used for native coronary vessel (n =129) or vein graft (n = 65) PCI were studied. FW debris was visually analyzed using a semi-quantitative grading score. Patients with "significant" debris (particles > or = 1 mm diameter) were compared with those with "nonsignificant" debris (no debris or particles <1 mm) with respect to clinical (age, gender, coronary disease risk factors, clinical presentation, periprocedural medications), and angiographic (vessel treated, vessel size, lesion length, lesion characteristics, angiographic thrombus and TIMI flow before and after PCI) variables.


RESULTS
Significant debris was retrieved in 55% of patients, more frequently from vein graft (69%) than native vessel lesions (48%, p = 0.006). No clinical characteristics predicted significant debris retrieval. Angiographic predictors of significant debris by multivariate analysis were longer stent length and final TIMI flow <3 (p = 0.009 and 0.007, respectively).


CONCLUSIONS
Longer stent length, likely reflecting increased lesion length and plaque burden, predicted significant distal embolism during PCI in native vessel and vein graft lesions, as assessed by debris collected in a distal vascular protection device. This suggests that use of vascular protection devices should be considered during PCI of long lesions.
Green Lane Cardiovascular Unit, Auckland City Hospital, Auckland, New Zealand. seif.eljack@waitematadhb.govt.nz
Seif S
SS
El-Jack
Pornratanarangsi
P
Suwatchai
James T
JT
Stewart
Peter N
PN
Ruygrok
John A
JA
Ormiston
Teena
T
West
Mark W I
MW
Webster
D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000628:therapy*; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D015897:Comorbidity; D017023:Coronary Angiography; D004617:Embolism / Q000517:prevention & control*; D005260:Female; D005374:Filtration; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019736:Prostheses and Implants; D018570:Risk Assessment; D013927:Thrombosis / Q000517:prevention & control*