Abstract
Background: Saphenous vein graft (SVG) intervention is associated with a significant incidence of major adverse cardiac events (MACE) related to distal vessel embolization. The FilterWire™ distal embolic protection device has recently been approved as an adjunct to SVG intervention. We report here our initial experience in a single center in 30 consecutive patients using this device in SVG stenting.
Hypothesis: This study examined the outcomes and complications associated with these devices, as well as whether proficiency with the devices increased with greater experience and whether there were measurable outcome differences between devices.
Methods: We retrospectively identified all patients in whom a FilterWire device was placed at our hospital between June 2001 and June 2004.
Results: The device was successfully deployed in 29 of 30 patients, and all patients were stented successfully. Overall MACE rate was 6.6%, consistent with reports in larger multi‐center clinical trials. Transient decreases in flow were noted while the device was in place in six patients, but improved in five patients with device removal.
Conclusions: This early experience in a single center using FilterWire embolic protection indicates that excellent clinical results can be obtained by the adoption of filter protection for SVG intervention, without evidence for a detrimental learning curve.
Keywords: distal protection, saphenous vein graft, angioplasty, coronary stent
Full Text
The Full Text of this article is available as a PDF (56.0 KB).
References
- 1. Keeley EC, Velez CA, O'Neill WW, Safian RD: Long‐term clinical outcome and predictors of major adverse cardiac events after percutaneous interventions on saphenous vein grafts. J Am Coll Cardiol 2001; 38: 659–665 [DOI] [PubMed] [Google Scholar]
- 2. Hong MK, Mehran R, Dangas G, Mintz GS, Lansky AJ, Pichard AD, Kent KM, Satler LF, Stone GW, Leon MB: Creatine kinase‐MB enzyme elevation following successful saphenous vein graft intervention is associated with late mortality. Circulation 1999; 100: 2400–2405 [DOI] [PubMed] [Google Scholar]
- 3. Hong MK, Mehran R, Dangas G, Mintz GS, Lansky A, Kent KM, Pichard AD, Satler LF, Stone GW, Leon MB: Are we making progress with percutaneous saphenous vein graft treatment? A comparison of 1990 to 1994 and 1995 to 1998 results. J Am Coll Cardiol 2001; 38: 150–154 [DOI] [PubMed] [Google Scholar]
- 4. de Feyter PJ: Percutaneous treatment of saphenous vein bypass graft obstructions : A continuing obstinate problem. Circulation 2003; 107: 2284–2286 [DOI] [PubMed] [Google Scholar]
- 5. Piana RN, Paik GY, Moscucci M, Cohen DJ, Gibson CM, Kugelmass AD, Carrozza JP Jr, Kuntz RE, Baim DS: Incidence and treatment of “no‐reflow” after percutaneous coronary intervention. Circulation 1994; 89: 2514–2518 [DOI] [PubMed] [Google Scholar]
- 6. Baim DS, Wahr D, George B, Leon MB, Greenberg J, Cutlip DE, Kaya U, Popma JJ, Ho KK, Kuntz RE: Randomized trial of a distal embolic protection device during percutaneous intervention of saphenous vein aorto‐coronary bypass grafts. Circulation 2002; 105: 1285–1290 [PubMed] [Google Scholar]
- 7. Stone GW, Rogers C, Hermiller J, Feldman R, Hall P, Haber R, Masud A, Cambier P, Caputo RP, Turco M, Kovach R, Brodie B, Herrmann HC, Kuntz RE, Popma JJ, Ramee S, Cox DA: Randomized comparison of distal protection with a filter‐based catheter and a balloon occlusion and aspiration system during percutaneous intervention of diseased saphenous vein aorto‐coronary bypass grafts. Circulation 2003; 108: 548–553 [DOI] [PubMed] [Google Scholar]
- 8. Swaminathan A, Stone GW, Rogers C, Hermiller J, Feldman R, Hall P, Haber R, Masud AR, Cambier P, Caputo RP, Cox DA, Mehran R, Herrmann HC: Influence of vessel diameter on the efficacy of distal protection devices during saphenous vein graft intervention. Am J Cardiol 2005; 95: 651–654 [DOI] [PubMed] [Google Scholar]
- 9. Popma JJ, Cox N, Hauptmann KE, Reifart N, Virmani R, Emira K, Murphy S, Gibson CM, Grube E: Initial clinical experience with distal protection using the FilterWire in patients undergoing coronary artery and saphenous vein graft percutaneous intervention. Cathet Cardiovasc Intervent 2002; 57: 125–134 [DOI] [PubMed] [Google Scholar]
- 10. Cox D, Masud A, Myers F, Kovach R, Cambier P, Brodie BR, Mishkel G, Hermiller J, Tully G, Stone G: Stenting in saphenous vein grafts with distal protection using the second generation FilterWire EZ: The BLAZE registry (abstr). Am J Cardiol 2003; 92 (suppl 6): 33L 12842241 [Google Scholar]
- 11. Gick M, Jander N, Bestehorn H, Kienzle RP, Ferenc M, Werner K, Comberg T, Peitz K, Zohnhofer D, Bassignana V, Buettner H, Neumann FJ: Randomized evaluation of the effect of filter‐based distal protection on myocardial perfusion and infarct size after primary percutaneous catheter intervention in myocardial infarction with and without ST elevation. Circulation 2005; 112: 1462–1469 [DOI] [PubMed] [Google Scholar]
- 12. Stone GW, Webb J, Cox DA, Brodie BR, Qureshi M, Kalynych A, Turco M, Schultheiss HP, Dulas D, Rutherford BD, Antoniucci D, Krucoff MW, Gibbons RJ, Jones D, Lansky AJ, Mehran R: Distal microcirculatory protection during percutaneous coronary intervention in acute ST‐segment elevation myocardial infarction: A randomized controlled trial. J Am Med Assoc 2005; 293: 1063–1072 [DOI] [PubMed] [Google Scholar]