title: Contemporary use of embolic protection devices in saphenous vein graft interventions: Insights from the stenting of saphenous vein grafts trial.
abstract: BACKGROUND
  We sought to evaluate the contemporary use of embolic protection devices (EPDs) in saphenous vein graft (SVG) interventions.
  
  
  METHODS
  We examined EPD use in the stenting of saphenous vein grafts (SOS) trial, in which 80 patients with 112 lesions in 88 SVGs were randomized to a bare metal stent (39 patients, 43 grafts, and 55 lesions) or paclitaxel-eluting stent (41 patients, 45 grafts, and 57 lesions).
  
  
  RESULTS
  An EPD was used in 60 of 112 lesions (54%). A Filterwire (Boston Scientific) was used in 70% of EPD-treated lesions, Spider (ev3, Plymouth, Minnesota) in 12%, Proxis (St. Jude, Minneapolis, Minnesota) in 12%, and Guardwire (Medtronic, Santa Rosa, California) in 7%. Of the remaining 52 lesions, an EPD was not utilized in 13 lesions (25%) because the lesion was near the distal anastomosis, in 14 lesions (27%) because of an ostial location, in one lesion (2%) because of small SVG size, in two in-stent restenosis lesions (4%) because of low distal embolization risk, and in 22 lesions (42%) because of operator's preference even though use of an EPD was feasible. Procedural success was achieved in 77 patients (96%); in one patient a Filterwire was entrapped requiring emergency coronary bypass graft surgery and two patients had acute stent thrombosis.
  
  
  CONCLUSIONS
  In spite of their proven efficacy, EPDs were utilized in approximately half of SVG interventions in the SOS trial. Availability of a proximal protection device could allow protection of approximately 25% of unprotected lesions, yet operator discretion appears to be the major determinant of EPD use.
authors.affiliation: Department of Cardiology, VA North Texas Healthcare System, Dallas, Texas, USA.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Badhey
authors.forename: Christopher
authors.initials: C
authors.lastname: Lichtenwalter
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.forename: Michele
authors.initials: M
authors.lastname: Roesle
authors.forename: Owen
authors.initials: O
authors.lastname: Obel
authors.forename: Tayo A
authors.initials: TA
authors.lastname: Addo
authors.forename: Donald
authors.initials: D
authors.lastname: Haagen
authors.forename: Abdul-Rahman
authors.initials: AR
authors.lastname: Abdel-Karim
authors.forename: Bilal
authors.initials: B
authors.lastname: Saeed
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Bissett
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sachdeva
authors.forename: Vassilios V
authors.initials: VV
authors.lastname: Voudris
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Karyofillis
authors.forename: Biswajit
authors.initials: B
authors.lastname: Kar
authors.forename: James
authors.initials: J
authors.lastname: Rossen
authors.forename: Panayotis
authors.initials: P
authors.lastname: Fasseas
authors.forename: Peter B
authors.initials: PB
authors.lastname: Berger
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D054855:Drug-Eluting Stents; D004617:Embolism / Q000209:etiology / Q000517:prevention & control*; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D011474:Prosthesis Design; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000637:transplantation*; D016037:Single-Blind Method; D015607:Stents; D016896:Treatment Outcome; D014481:United States
chemical_list: D008670:Metals