title: Filter no-reflow during percutaneous coronary intervention of saphenous vein grafts: incidence, predictors and effect of the type of protection device.
abstract: OBJECTIVE
  To assess the main predictors and significance of filter no-reflow (FNR) in protected saphenous vein graft (SVG) percutaneous coronary intervention (PCI) and the effect of two different filter-based devices on FNR incidence. The phenomenon of FNR has been described as a transient impairment of blood flow due to debris plugging of a filter-based device used to shield the distal microvasculature during SVG PCI.
  
  
  RESULTS
  Fifty consecutive patients treated with SVG PCI were enrolled, using two different filter-based devices (FilterWire EZ™ [Boston Scientific, Natick, MA, USA] and SpiderRX® [Ev3, Plymouth, MN, USA]). We evaluated: 1) the value of clinical and angiographic variables for predicting FNR including the recently-described "degeneration score" (DS); 2) the predictive value of FNR for post-procedural (type IVa) myocardial infarction (MI); 3) the effect of filter type on incidence of FNR. FNR was observed in 30% of patients and was predicted by a higher DS at baseline (2.1±0.9 vs. 1.4±0.8, p=0.02, respectively) as well as by the type of filter used (54% vs. 23% in SpiderFX and FilterWire EZ, respectively, p=0.04). However, at multivariate analysis DS was the only independent predictor of FNR (OR 2.47, CI 95% 1.06-5.76, p=0.04). Graft age and FNR were found to be independent predictors of type IVa MI (OR 1.28; CI%E2%80%AF95% 1.01-1.64, p=0.04 and OR 15.69; CI%E2%80%AF95% 2.12-116.39, p=0.007, respectively).
  
  
  CONCLUSIONS
  FNR is a common complication of protected SVG stenting. FNR occurs mainly in grafts with a high degeneration score, and the presence of FNR predicts post-procedural myocardial infarction.
authors.affiliation: Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. italo.porto@gmail.com
authors.forename: Italo
authors.initials: I
authors.lastname: Porto
authors.forename: Flavia
authors.initials: F
authors.lastname: Belloni
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.forename: Claudio
authors.initials: C
authors.lastname: Larosa
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Leone
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
authors.forename: Giovanni Luigi
authors.initials: GL
authors.lastname: De Maria
authors.forename: Christian
authors.initials: C
authors.lastname: Hamilton-Craig
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D000368:Aged; D000792:Angiography; D017130:Angioplasty / Q000009:adverse effects*; D057505:Embolic Protection Devices; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D054318:No-Reflow Phenomenon / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D020107:Troponin T / Q000097:blood
chemical_list: D020107:Troponin T