PREDICTORS AND SEQUELAE OF DISTAL EMBOLIZATION DURING SAPHENOUS-VEIN GRAFT INTERVENTION FROM THE CAVEAT-II TRIAL

Background The purpose of this study was to identify the predictors an d sequelae of distal embolization from a multicenter, randomized trial of saphenous vein graft intervention. The CAVEAT-II trial demonstrate d that saphenous vein graft directional coronary atherectomy (DCA) was associated with greater angiographic success and less need for repeat intervention compared with percutaneous transluminal coronary angiopl asty (PTCA) but at the cost of more acute complications-notably distal embolization. Methods and Results In CAVEAT-II, 305 patients were ran domly assigned to DCA (149 patients) or PTCA (156 patients) for lesion s with >60% diameter stenosis in vein grafts greater than or equal to 3 mm in diameter. Distal embolization occurred in 20 patients (13.4%) assigned to DCA and 8 patients (5.1%) assigned to PTCA (P=.011). Indep endent predictors of distal embolization were use of DCA (71% in dista l embolization patients versus 47% in patients without distal emboliza tion, P=.011) and presence of thrombus (39% in distal embolization pat ients Versus 14% in patients without distal embolization, P<.00). In-h ospital adverse events were more frequent after distal embolization: 7 1% versus 20%, odds ratio plus (95% confidence intervals) 9.87 (4.65, 20.94). At 12-month follow-up, adverse event rates were also higher in patients with distal embolization (odds ratio, 3.05 [1.95, 4.76]). Co nclusions In this first prospective multicenter trial of saphenous vei n graft intervention, distal embolization was more common after DCA th an PTCA and in lesions containing thrombus. It also was associated wit h worse in-hospital and 12-month outcomes. The risk and sequelae of di stal embolization should be considered when choosing a treatment strat egy for vein graft disease.