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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

View larger version (29K): [in a new window]   Figure 1 Schematic of the particulate retrieval system.

View larger version (69K): [in a new window]   Figure 2 Photograph of distal occlusion balloon and aspiration catheter.

View larger version (47K): [in a new window]   Figure 3 Diagrammatic representation of the mechanism of particulate containment and retrieval.

View larger version (61K): [in a new window]   Figure 4 (A) Angiogram demonstrates ulcerated stenosis in a 10-year-old graft to a circumflex coronary artery. (B) During angioplasty the occlusive distal balloon prevents graft outflow. Before deflation of the distal occlusion balloon, particulate debris is aspirated and removed. (C) The graft is widely patent with normal flow.

View larger version (89K): [in a new window]   Figure 5 Representative micrographs of plaque material from vein graft aspirates. (A) Fibrous cap (FC) overlying a lipid-rich necrotic core (NC) containing numerous cholesterol clefts (arrows, Movat Pentachrome, x200). (B) Section stained using the monoclonal antibody CD68/KP-1 (Dako Inc., Carpinteria, California) for recognition of resident macrophages (dark brown reaction product, x200). (C) Immunostaining of aspirate material with the antibody HHF-35 (Enzo Inc., Farmingdale, New York) for recognition of smooth muscle cells (brown reaction product); note the paucity of staining (x100). (D) Necrotic core with plaque hemorrhage (red cells and fibrin, x200). (E) Aspirate material showing strands of collagen (arrow, H&E stain, x200). (F) Lipid-rich core area with cholesterol clefts (arrows, H&E stain, x200).

View larger version (167K): [in a new window]   Figure 6 Representative scanning electron micrographs of vein graft aspirate. (A) Shows tissue resembling a fibrous cap; the sample possibly rolled during removal or processing (scale = 20 µm). (B) Fragment of plaque material containing numerous cholesterol-laden macrophages; the rod-shaped fragment in the upper left is a cholesterol crystal (arrow, scale = 50 µm). (C) Particle showing a cluster of macrophages (scale = 10 µm). (D) Macrophages interspersed in a fragment of atherosclerotic plaque (scale = 20 µm).