Contemporary use of embolic protection devices in saphenous vein graft interventions: Insights from the stenting of saphenous vein grafts trial.
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.
Badhey
Neeraj
N
Department of Cardiology, VA North Texas Healthcare System, Dallas, Texas, USA.
Lichtenwalter
Christopher
C
de Lemos
James A
JA
Roesle
Michele
M
Obel
Owen
O
Addo
Tayo A
TA
Haagen
Donald
D
Abdel-Karim
Abdul-Rahman
AR
Saeed
Bilal
B
Bissett
Joseph K
JK
Sachdeva
Rajesh
R
Voudris
Vassilios V
VV
Karyofillis
Panagiotis
P
Kar
Biswajit
B
Rossen
James
J
Fasseas
Panayotis
P
Berger
Peter B
PB
Banerjee
Subhash
S
Brilakis
Emmanouil S
ES
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
D008670:Metals