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.
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Abbreviations and Acronyms
| | CK | = creatine kinase | | ECG | = electrocardiogram | | TIMI | = Thrombolysis in Myocardial Infarction trial |
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