Histopathology of material captured by embolic protection device after percutaneous coronary interventions in atherosclerotic saphenous vein grafts.
OBJECTIVE
Different distal protections devices have been developed to prevent embolisation during percutaneous coronary intervention (PCI) in atherosclerotic saphenous vein grafts (SVG). The purpose of this descriptive study was to characterise the composition of material captured by embolic protection device from saphenous vein graft interventions by light and electron microscopy, to determine the age of the thrombotic component and to relate the pathological findings to the clinical condition, lesion characteristics and to the use of conventional or membrane covered self-expanding stents during the intervention.


RESULTS
Forty consecutive patients treated with the FilterWire EX (Boston Scientific) during 42 SVG interventions were included. Plaque was found in 4.8%, thrombus in 16.7%, both plaque and thrombus in 69.0% of the filter bags, and 9.5% were empty. In 93% of the thrombus containing samples we found platelet aggregates that were formed within the last 10-15 minutes before fixation. This indicated platelet stimulation and aggregation during the PCI procedures. No relation was found between the composition of filter wire material and clinical condition, coronary lesion characteristics or the use of membrane covered self-expanding stents (Symbiot(R)).


CONCLUSIONS
The present study on material captured by embolic protein device after SVG interventions generated the hypothesis that these interventions were associated with acute platelet activation. In consequence, the use of glycoprotein IIb/IIIa inhibitors might be reconsidered in distal protected SVG interventions.
Steigen
Sonja E
SE
Department of Pathology, University Hospital of Northern Norway, Tromsø, Norway.
Steigen
Terje K
TK
Gunnes
Paul
P
Thuesen
Leif
L
Mannsverk
Jan
J
Jørgensen
Leif
L