title: Importance of Adjunct Delivery Techniques to Optimize Deployment Success of Distal Protection Filters During Vein Graft Intervention.
abstract: OBJECTIVE
  This study assessed the impact of adjunct delivery techniques on the deployment success of distal protection filters in saphenous vein grafts (SVGs).
  
  
  BACKGROUND
  Despite their proven clinical benefit, distal protection devices are underutilized in SVG interventions. Deployment of distal protection filters can be technically challenging in the presence of complex anatomy. Techniques that facilitate the delivery success of these devices could potentially improve clinical outcomes and promote greater use of distal protection.
  
  
  METHODS
  Outcomes of 105 consecutive SVG interventions with attempted use of a FilterWire distal protection device (Boston Scientific) were reviewed. In patients in whom filter delivery initially failed, the success of attempted redeployment using adjunct delivery techniques was assessed. Two strategies were utilized sequentially: (1) a 0.014" moderate-stiffness hydrophilic guidewire was placed first to function as a parallel buddy wire to support subsequent FilterWire crossing; and (2) if the buddy-wire approach failed, predilation with a 2.0 mm balloon at low pressure was performed followed by reattempted filter delivery.
  
  
  RESULTS
  The study population consisted of 80 men and 25 women aged 73 ± 10 years. Mean SVG age was 14 ± 6 years. Complex disease (American College of Cardiology/American Heart Association class B2 or C) was present in 92%. Initial delivery of the FilterWire was successful in 82/105 patients (78.1%). Of the 23 patients with initial failed delivery, 8 (35%) had successful deployment with a buddy wire alone, 7 (30%) had successful deployment with balloon predilation plus buddy wire, 4 (17%) had failed reattempt at deployment despite adjunct maneuvers, and in 4 (17%) no additional attempts at deployment were made at the operator's discretion. Deployment failure was reduced from 21.9% initially to 7.6% after use of adjunct delivery techniques (P<.01). No adverse events were observed with these measures.
  
  
  CONCLUSIONS
  Deployment of distal protection devices can be technically difficult with complex SVG disease. Adjunct delivery techniques are important to optimize deployment success of distal protection filters during SVG intervention.
authors.forename: Antony G
authors.initials: AG
authors.lastname: Kaliyadan
authors.forename: Harnish
authors.initials: H
authors.lastname: Chawla
authors.forename: David L
authors.initials: DL
authors.lastname: Fischman
authors.forename: Nicholas
authors.initials: N
authors.lastname: Ruggiero
authors.forename: Michael
authors.initials: M
authors.lastname: Gannon
authors.forename: Paul
authors.initials: P
authors.lastname: Walinsky
authors.affiliation: Jefferson Angioplasty Center, Thomas Jefferson University Hospital, 111 South 11th Street, Gibbon Building, Suite 6210, Philadelphia, PA 19107 USA. michael.savage@jefferson.edu.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Savage
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D057505:Embolic Protection Devices; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000637:transplantation*