Abstract 1722: Intravascular Ultrasound Predictors of No-Reflow after Percutaneous Saphenous Vein Graft Intervention Using Distal Protection Devices
We investigated the relationship between intravascular ultrasound (IVUS) findings and the no-reflow phenomenon in 125 patients with saphenous vein graft (SVG) lesions undergoing percutaneous coronary intervention (PCI) with distal protection devices. Angiographic no-reflow was defined as TIMI flow grade 0, 1, and 2. IVUS findings included ruptured plaque (a cavity that communicated with the lumen with an overlying residual fibrous cap fragment), multiple ruptured plaques (separated by a >5-mm length of artery containing smooth lumen contours), and plaque prolapse (PP, tissue extrusion through the stent struts whose volume was calculated by subtracting lumen volume from stent volume).
RESULTS: Post-PCI, no-reflow was observed in 19 patients (15.2%). In patients with no-reflow, lesion site lumen area was smaller; plaque burden and remodeling index were greater; the presence of plaque rupture, multiple plaque ruptures, and an intraluminal mass were more common; final stent CSA was greater; PP was more frequent; and maximum PP area and PP volume were greater. In multivariate logistic regression analysis, multiple plaque rupture (Odds ratio [OR]=7.97; 95% CI 1.90–33.50, p=0.005) and post-PCI PP (OR=4.02; 95% CI 1.25–12.95, p=0.020) were independent predictors of no-reflow post-PCI of SVG lesions - even using distal protection devices.
CONCLUSIONS: Even using distal protection devices, no-reflow was observed in 15% of SVG lesions post-PCI. Important IVUS predictors of no-reflow in these patients were multiple plaque rupture and post-PCI plaque prolapse.