Retrieval and analysis of particulate debris after saphenous vein graft intervention

OBJECTIVES This study was designed to evaluate the composition and quantity of particulate debris resulting from vein graft intervention. BACKGROUND Distal embolization and "no reflow" are frequent and important c omplications resulting from angioplasty of diseased saphenous vein grafts. Little is known about the composition and quantity of embolic particulate d ebris associated with vein graft intervention, and no intervention has been shown to protect against its clinical consequences. METHODS A catheter system, designed to contain, retrieve and protect agains t distal embolization of this material, was evaluated during 27 percutaneou s interventional saphenous vein graft procedures. Clinical, angiographic an d pathologic analyses were performed. RESULTS The duration of distal graft occlusion required to allow interventi on and subsequent debris removal was 150 +/- 54 s, decreasing as experience was gained. Thrombolysis in Myocardial Infarction trial (TIMI) flow grade increased from 2.6 +/- 0.8 to 3.0 +/- 0.0. Creatine kinase (CK) rose above normal in three patients (11.1%) exceeding 3x normal in one (3.7%) resultin g in the diagnosis of non-myocardial infarction. Particulate material was i dentified following 21 of 23 procedures suitable for analysis. Particle siz e was 204 +/- 57 mu m in the major axis and 83 +/- 22 mu m in the minor axi s. Particles consisted predominantly of soft acellular atheromatous materia l, such as that typically found under a fibrous cap. Semiquantitative analy sis suggested that the quantity of particulate material was less following stenting than following balloon dilation. CONCLUSIONS Particulate matter is commonly present following routine angiop lasty and stenting of saphenous Vein grafts. Containment, retrieval and ana lysis of this particulate debris are all feasible. Comparison to prior clin ical experience is limited by small sample size. However, to the extent tha t these particles may contribute to distal embolization, no-reflow and infa rction, such a system may contribute to the reduction of complications foll owing vein graft intervention. (C) 1999 by the American College of Cardiolo gy.