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(Circulation. 2004;109:1735-1740.)
© 2004 American Heart Association, Inc.

Clinical Investigation and Reports

Embolic Protection With Filtering or Occlusion Balloons During Saphenous Vein Graft Stenting Retrieves Identical Volumes and Sizes of Particulate Debris

Campbell Rogers, MD; Rany Huynh, BS; Philip A. Seifert, MS; Bernard Chevalier, MD; Joachim Schofer, MD; Elazer R. Edelman, MD, PhD; Gregory Toegel, BS; Arun Kuchela, MD; Amy Woupio, BS; Richard E. Kuntz, MD; Natalie D. Macon, PhD

From the Cardiovascular Division (Cardiac Catheterization Laboratory and Coronary Care Unit), Brigham and Women’s Hospital, Harvard Medical School (C.R., E.R.E., A.K., R.E.K.), Boston, Mass; Medtronic, Inc (R.H., A.W., N.D.M.), Danvers, Mass; Harvard-M.I.T. Division of Health Sciences and Technology, Massachusetts Institute of Technology (C.R., P.A.S., E.R.E., G.T.), Cambridge, Mass; Center Cardiologique du Nord (B.C.), Saint Denis, France; and Center of Cardiology and Vascular Intervention (J.S.), Hamburg, Germany.

Correspondence to Campbell Rogers, MD, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail crogers{at}partners.org

Received January 6, 2003; de novo received October 21, 2003; revision received January 9, 2004; accepted January 23, 2004.

Background— Distal embolization of plaque particulate liberated during stenting may cause periprocedural complications. The number, size, and volume of debris released during stenting, however, have not been quantified, rendering embolic protection approaches empiric. We used a novel method of microparticle size assessment to measure volume and characterize individual sizes of particles captured by the PercuSurge GuardWire balloon or a vascular filter during saphenous vein graft stenting.

Methods and Results— Braided nitinol filters (average distal pore size 100 µm) were used in 47 saphenous vein grafts in 44 patients. The PercuSurge GuardWire was used in 17 saphenous vein grafts in 16 patients. Particulate debris was subjected to microparticle size analysis (RapidVue, Beckman Coulter). All samples contained particulate debris. For both filter and GuardWire populations, most particles were <100 µm in longest dimension (87% and 90% of particles, respectively), and the distribution of particle sizes was identical. Total embolic load per lesion for both filters and GuardWire aspirates was also similar: median embolic load per filter was 16 mm³ (range 2 to 84 mm³). Median embolic load per GuardWire was also 16 mm³ (range 7 to 42 mm³). Histopathologic analysis demonstrated that most samples contained plaque elements and platelet-rich thrombus.

Conclusions— During saphenous vein graft interventions, particulate retrieved with a vascular filtering device or an occlusion balloon was similar in amount and character. This supports the notion that unless soluble mediators play an important role in adverse acute clinical events after stenting, the clinical efficacy of filtering devices may be equal to that of occlusion devices.

Key Words: bypass • embolism • myocardial infarction • stents

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