CLINICAL STUDIES
Retrieval and analysis of particulate debris after saphenous vein graft intervention
John G. Webb, MD, FACC* ||,1,
Ronald G. Carere, MD, FACC* ||,
Renu Virmani, MD ||,
Donald Baim, MD, FACC ||,2,
Paul S. Teirstein, MD, FACC ||,
Patrick Whitlow, MD, FACC|| ¶,
Colleen McQueen, RN|| #,2,
Frank D. Kolodgie, PhD ||,
Elizabeth Buller, RN* ||,
Arthur Dodek, MD, FACC* ||,
G. B. John Mancini, MD, FACC** || and
Stephen Oesterle, MD, FACC||
* St. Paul’s Hospital, University of British Columbia, Vancouver, Canada
Armed Forces Institute of Pathology, Washington, DC, USA
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
Scripps Clinic, La Jolla, California, USA
|| Oschner Medical Clinic, New Orleans, Louisiana, USA
¶ Cleveland Clinic Foundation, Cleveland, Ohio, USA
# PercuSurge, Sunnyvale, California, USA
** Vancouver Hospital and Health Sciences Centre, Vancouver, Canada
Stanford University Medical Center, Stanford, California, USA
Manuscript received July 14, 1998;
revised manuscript received January 25, 1999,
accepted April 9, 1999.
Reprint requests and correspondence: Dr. John Webb, Director of Interventional Cardiology, St. Paul’s Hospital, 502-1160 Burrard Street, Vancouver, British Columbia, Canada V6Z 2E8
johnwebb{at}bc.sympatico.ca
OBJECTIVES
This study was designed to evaluate the composition and quantity of particulate debris resulting from vein graft intervention.
BACKGROUND
Distal embolization and "no reflow" are frequent and important complications resulting from angioplasty of diseased saphenous vein grafts. Little is known about the composition and quantity of embolic particulate debris associated with vein graft intervention, and no intervention has been shown to protect against its clinical consequences.
METHODS
A catheter system, designed to contain, retrieve and protect against distal embolization of this material, was evaluated during 27 percutaneous interventional saphenous vein graft procedures. Clinical, angiographic and pathologic analyses were performed.
RESULTS
The duration of distal graft occlusion required to allow intervention and subsequent debris removal was 150 ± 54 s, decreasing as experience was gained. Thrombolysis in Myocardial Infarction trial (TIMI) flow grade increased from 2.6 ± 0.8 to 3.0 ± 0.0. Creatine kinase (CK) rose above normal in three patients (11.1%) exceeding 3x normal in one (3.7%) resulting in the diagnosis of non-Q-myocardial infarction. Particulate material was identified following 21 of 23 procedures suitable for analysis. Particle size was 204 ± 57 µm in the major axis and 83 ± 22 µm in the minor axis. Particles consisted predominantly of soft acellular atheromatous material, such as that typically found under a fibrous cap. Semiquantitative analysis suggested that the quantity of particulate material was less following stenting than following balloon dilation.
CONCLUSIONS
Particulate matter is commonly present following routine angioplasty and stenting of saphenous vein grafts. Containment, retrieval and analysis of this particulate debris are all feasible. Comparison to prior clinical experience is limited by small sample size. However, to the extent that these particles may contribute to distal embolization, no-reflow and infarction, such a system may contribute to the reduction of complications following vein graft intervention.
|
Abbreviations and Acronyms
| | CK | = creatine kinase | | ECG | = electrocardiogram | | TIMI | = Thrombolysis in Myocardial Infarction trial |
|
This article has been cited by other articles:
|
|
|
|
 
M.-H. Jim, K.-H. Yiu, R. L.-Y. Ko, C.-W. Siu, and W.-H. Chow
Virtual Histology of Aneurysmal Lesion in Aortocoronary Saphenous Vein Graft
Asian Cardiovasc Thorac Ann,
October 1, 2009;
17(5):
539 - 540.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Tanaka, T. Imanishi, H. Kitabata, T. Kubo, S. Takarada, T. Tanimoto, A. Kuroi, H. Tsujioka, H. Ikejima, K. Komukai, et al.
Lipid-rich plaque and myocardial perfusion after successful stenting in patients with non-ST-segment elevation acute coronary syndrome: an optical coherence tomography study
Eur. Heart J.,
June 1, 2009;
30(11):
1348 - 1355.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. J. Kereiakes, M. A. Turco, J. Breall, N. Z. Farhat, R. L. Feldman, B. McLaurin, J. J. Popma, L. Mauri, P. Zimetbaum, J. Massaro, et al.
A Novel Filter-Based Distal Embolic Protection Device for Percutaneous Intervention of Saphenous Vein Graft Lesions: Results of the AMEthyst Randomized Controlled Trial
J. Am. Coll. Cardiol. Intv.,
June 1, 2008;
1(3):
248 - 257.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Bittl
Damage Control for Renal Artery Stenting
Circulation,
May 27, 2008;
117(21):
2724 - 2726.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Cuisset, M. Hamilos, N. Melikian, E. Wyffels, J. Sarma, G. Sarno, E. Barbato, J. Bartunek, W. Wijns, and B. De Bruyne
Direct stenting for stable angina pectoris is associated with reduced periprocedural microcirculatory injury compared with stenting after pre-dilation.
J. Am. Coll. Cardiol.,
March 18, 2008;
51(11):
1060 - 1065.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Coolong, D. S. Baim, R. E. Kuntz, A. J. O'Malley, S. Marulkar, D. E. Cutlip, J. J. Popma, and L. Mauri
Saphenous Vein Graft Stenting and Major Adverse Cardiac Events: A Predictive Model Derived From a Pooled Analysis of 3958 Patients
Circulation,
February 12, 2008;
117(6):
790 - 797.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. Wilson and J. T. Willerson
Myocardial Revascularization with Percutaneous Devices
Card. Surg. Adult,
January 1, 2008;
3(2008):
573 - 598.
[Full Text]
|
|
|
|
|
|
|
M. Jonas, G. W. Stone, R. Mehran, J. Hermiller, R. Feldman, H. C. Herrmann, D. A. Cox, R. E. Kuntz, J. J. Popma, C. Rogers, et al.
Platelet glycoprotein IIb/IIIa receptor inhibition as adjunctive treatment during saphenous vein graft stenting: differential effects after randomization to occlusion or filter-based embolic protection
Eur. Heart J.,
April 2, 2006;
27(8):
920 - 928.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Herrmann
Peri-procedural myocardial injury: 2005 update
Eur. Heart J.,
December 1, 2005;
26(23):
2493 - 2519.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. P. Carrozza Jr, M. Mumma, J. A. Breall, A. Fernandez, E. Heyman, C. Metzger, and for the PRIDE Study Investigators
Randomized Evaluation of the TriActiv Balloon-Protection Flush and Extraction System for the Treatment of Saphenous Vein Graft Disease
J. Am. Coll. Cardiol.,
November 1, 2005;
46(9):
1677 - 1683.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Mizote, Y. Ueda, T. Ohtani, M. Shimizu, Y. Takeda, T. Oka, M. Tsujimoto, A. Hirayama, M. Hori, and K. Kodama
Distal Protection Improved Reperfusion and Reduced Left Ventricular Dysfunction in Patients With Acute Myocardial Infarction Who Had Angioscopically Defined Ruptured Plaque
Circulation,
August 16, 2005;
112(7):
1001 - 1007.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. M. Malyar, L. O. Lerman, M. Gossl, P. E. Beighley, and E. L. Ritman
Relation of Nonperfused Myocardial Volume and Surface Area to Left Ventricular Performance in Coronary Microembolization
Circulation,
October 5, 2004;
110(14):
1946 - 1952.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Angelini, P. Rubartelli, F. Mistrorigo, M. Della Barbera, F. Abbadessa, M. Vischi, G. Thiene, and S. Chierchia
Distal Protection With a Filter Device During Coronary Stenting in Patients With Stable and Unstable Angina
Circulation,
August 3, 2004;
110(5):
515 - 521.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Sato, H. Iida, A. Tanaka, H. Tanaka, S. Shimodouzono, E. Uchida, T. Kawarabayashi, and J. Yoshikawa
The decrease of plaque volume during percutaneous coronary intervention has a negative impact on coronary flow in acute myocardial infarction: A major role of percutaneous coronary intervention-induced embolization
J. Am. Coll. Cardiol.,
July 21, 2004;
44(2):
300 - 304.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. V. Kaplan, D. S. Baim, J. J. Smith, D. A. Feigal, M. Simons, D. Jefferys, T. J. Fogarty, R. E. Kuntz, and M. B. Leon
Medical Device Development: From Prototype to Regulatory Approval
Circulation,
June 29, 2004;
109(25):
3068 - 3072.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Rogers, R. Huynh, P. A. Seifert, B. Chevalier, J. Schofer, E. R. Edelman, G. Toegel, A. Kuchela, A. Woupio, R. E. Kuntz, et al.
Embolic Protection With Filtering or Occlusion Balloons During Saphenous Vein Graft Stenting Retrieves Identical Volumes and Sizes of Particulate Debris
Circulation,
April 13, 2004;
109(14):
1735 - 1740.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. E. Scoble
Do protection devices have a role in renal angioplasty and stent placement?
Nephrol. Dial. Transplant.,
September 1, 2003;
18(9):
1700 - 1703.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G Sangiorgi and A Colombo
Embolic protection devices
Heart,
September 1, 2003;
89(9):
990 - 992.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. T. Ashby, G. Dangas, E. A. Aymong, I. Iakovou, F. Kuepper, R. Mehran, G. W. Stone, M. B. Leon, and J. W. Moses
Effect of percutaneous coronary interventions for in-stent restenosis in degenerated saphenous vein grafts without distal embolic protection
J. Am. Coll. Cardiol.,
March 5, 2003;
41(5):
749 - 752.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. J. Kereiakes
Platelet Glycoprotein IIb/IIIa Inhibition and Atheroembolism During Bypass Graft Angioplasty: A Cup Half Full
Circulation,
December 10, 2002;
106(24):
2994 - 2996.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Muller-Hulsbeck, J. Grimm, C. Liess, J. Hedderich, M. Bergmeyer, and M. Heller
Comparison and Modification of Two Cerebral Protection Devices Used for Carotid Angioplasty: In Vitro Experiment
Radiology,
October 1, 2002;
225(1):
289 - 294.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. L. Whitlow, P. Lylyk, H. Londero, O. A. Mendiz, K. Mathias, H. Jaeger, J. Parodi, C. Schonholz, and J. Milei
Carotid Artery Stenting Protected With an Emboli Containment System
Stroke,
May 1, 2002;
33(5):
1308 - 1314.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. H. Rezkalla and R. A. Kloner
No-Reflow Phenomenon
Circulation,
February 5, 2002;
105(5):
656 - 662.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Angelini, B. Reimers, M. D. Barbera, S. Sacca, G. Pasquetto, C. Cernetti, M. Valente, P. Pascotto, and G. Thiene
Cerebral Protection During Carotid Artery Stenting: Collection and Histopathologic Analysis of Embolized Debris
Stroke,
February 1, 2002;
33(2):
456 - 461.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. C. Keeley, C. A. Velez, W. W. O'Neill, and R. D. Safian
Long-term clinical outcome and predictors of major adverse cardiac events after percutaneous interventions on saphenous vein grafts
J. Am. Coll. Cardiol.,
September 1, 2001;
38(3):
659 - 665.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E Eeckhout and M.J Kern
The coronary no-reflow phenomenon: a review of mechanisms and therapies
Eur. Heart J.,
May 1, 2001;
22(9):
729 - 739.
[PDF]
|
|
|
|
|
|
|
A. Tanaka, T. Kawarabayashi, Y. Nishibori, T. Sano, Y. Nishida, D. Fukuda, K. Shimada, and J. Yoshikawa
No-Reflow Phenomenon and Lesion Morphology in Patients With Acute Myocardial Infarction
Circulation,
May 7, 2002;
105(18):
2148 - 2152.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
