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New Recommendations for Vein Graft PCI |
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Embolic Protection of Saphenous Vein Graft Percutaneous Interventions |
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Jaafer Golzar, M.D., et. al., Dr. Golzar is an Interventional Cardiologist with Heart Care Centers of Illinois Full text PDF of "Embolic Protection of Saphenous Vein Graft Percutaneous Interventions |
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Despite the advances of modern interventional cardiology, coronary artery bypass grafting (CABG) remains part of the armamentarium of coronary revascularization. Although the use of coronary bypass grafts has diminished in recent years there have been approximately 1.5 million isolated bypass procedures performed over the past 10 years. Although many of these surgeries utilize arterial graft conduits, most involve the use of one or more saphenous vein grafts. Despite improved surgical techniques and cryopreservation these grafts immediately develop intimal hyperplasia.  Distal embolization of atheroemboli is a well-known consequence of SVG interventions and may result in diminished blood flow to the distal vascular bed resulting in peri-procedural ischemia and infarction. This appropriately named "no-reflow" phenomenon occurs as a result of distal embolization
of atheroembolic debris resulting in spasm of the microcirculation, local platelet activation, or a combination of these factors and may occur in 3-9% of SVG intervention. Particulate matter is commonly present following routine angioplasty and stenting of saphenous vein grafts. In fact, an early study of a distal balloon occlusion and aspiration system showed that particulate debris was retrieved in 21 of 23 patients. As expected, no-reflow is associated with worse clinical outcomes including postprocedural myocardial infarction (17.7% vs. 3.5% in patients with and without no-reflow, respectively) and death (7.4% vs. 2%). Various techniques, both interventional and pharmacologic, have been used in the treatment of no-reflow.
Dr. Golzar concludes: Distal embolization of atheroemboli is a well-known consequence of SVG interventions resulting in diminished blood flow to the distal vascular bed and possibly resulting in peri-procedural ischemia and infarction. Embolic risk varies according to angiographic characteristics, degree of SVG degeneration, and plaque burden. Despite this, distal embolization remains unpredictable. The use of embolic protection devices significantly reduces embolization rates by 40-50% and decreases peri-procedural MACE (Major Adverse Cardiac Events) across all subsets. With limited exceptions these devices should be utilized in all SVG interventions. For the full text of Dr. Golzar's article...please click below: Full text PDF of "Embolic Protection of Saphenous Vein Graft Percutaneous Interventions |
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