Prevention of distal embolization during saphenous vein graft lesion angioplasty - Experience with a new temporary occlusion and aspiration system

Background-Repeat coronary artery bypass graft surgery (CABG) is associated with a high morbidity and mortality, rendering percutaneous treatment of s aphenous vein graft (SVG) lesions an attractive alternative. However, percu taneous interventions of degenerated SVGs carries high risk of distal embol ization, Methods and Results-This study reports our initial experience with the Perc uSurge GuardWire, a new device developed to prevent embolization during tre atment of degenerated SVG. This device consists of a 190-cm-long, hollow 0. 014-in guidewire with a central lumen connected to a distal occlusion ballo on. A dedicated inflation device (the MicroSeal Adapter) was used to inflat e the distal balloon and maintain complete lumen occlusion during balloon d ilatation and stent implantation. A monorail aspiration catheter, connected to a vacuum syringe, was used to evacuate atherosclerotic and thrombotic d ebris. Angioplasty with stent implantation was performed in 15 degenerated SVGs (18 lesions). Procedural success was achieved in all patients with nor mal postprocedure flow (Thrombolysis in Myocardial Infarction grade 3). No distal embolization was observed. There were no major in-hospital adverse c linical events, including Q-wave or non-Q-wave myocardial infarction, emerg ency CABG, or death. All patients were asymptomatic at discharge. Conclusions-This preliminary series supports the feasible use of the PercuS urge GuardWire for retrieval of plaque debris and prevention of embolizatio n in degenerated SVGs. The good tolerance of temporary occlusions without a ngiographic or clinical evidence of distal embolization represents encourag ing early findings.