A Graphic Demonstration of the Value of Embolic Protection Devices
Embolic protection devices are now accepted adjuncts in the prevention of coronary embolization during percutaneous intervention of saphenous vein grafts. Efficacy has been demonstrated in clinical trials, which have shown a reduction in slow flow and myocardial necrosis.1 Approved devices rely on either balloon occlusion of the vessel, with thrombus extraction (eg, PercuSurge GuardWire, Medtronic), or capture of the embolized material in a filter-based device (eg, Filterwire-Ex, Boston Scientific, or Angioguard, Cordis Corp). We illustrate the use of a Filterwire-Ex in a coronary vein graft intervention, with angiographic and direct visual evidence of effective distal embolic protection. The patient is a 77-year-old male with a history of coronary artery bypass 20 years before presentation. He was admitted with symptoms of an acute coronary syndrome that were unresponsive to medical therapy. Angiography demonstrated a severe stenosis, with probable thrombus in the saphenous venous graft to the circumflex coronary artery (Figure 1A). A Filterwire was passed into the distal portion of the graft, the filter was deployed, and subsequent proximal graft intervention was performed with balloon inflation and stent implantation. The sequence of images (Figures 1B through 1D) dramatically demonstrates the fluoroscopic appearance of the thrombus as it migrates downstream into the Filterwire basket, where it was successfully retrieved (Figure 2).
The online-only Data Supplement can be found at http://circ.ahajournals.org/cgi/content/full/112/18/e302/DC1.
Baim DS, Wahr D, George B, Leon MB, Greenberg J, Cutlip DE, Kaya U, Popma JJ, Ho KK, Kuntz RE, for the Saphenous vein graft Angioplasty Free of Emboli Randomized (SAFER) Trial Investigators. Randomized trial of a distal embolic protection device during percutaneous intervention of saphenous vein aorto-coronary bypass grafts. Circulation. 2002; 105: 1285–1290.