Clinical experience with the PercuSurge GuardWire (TM) - a new device for protection from peripheral embolism during catheter interventions in degenerated aorto-coronary saphenous vein grafts

Periperal embolisation is a typical complication of catheter interventions in degenerated aortocoronary saphenous vein grafts. Alternative techniques, such as transluminal extraction catheter (TEC), directional coronary athre ctomy (DCA) and eximer laser angioplasty (ELCA) were not able to reduce the risk of peripheral vessel occlusion or " no-reflow". For the protection from peripheral embolisation we used the PercuSurge Guar dWire(TM) Temporary Occlusion & Aspiration System (PercuSurge Inc., Sunnyva le, USA) in 55 patients with 58 stenosis in degenerated saphenous vein graf ts. The primary endpoint of this consecutive series was to access the effic acy of the system by postinterventional TIMI flow and determination of seri al CW/CK-MB. The intervention was primarily successful in 55 of 58 cases (94.8%), with a reduction in stenosis from 87.6% (range 75-100%) to 4.5% (range 0-40%). TI MI flow improved from a mean of 2.1+/-1.4 to 2.9+/-0.4 after intervention. CW/CK-MB levels were 24/5, 27/7 and 26/ 6 U/l (mean values) before, 8 hours , 16 hours and 24 hours after intervention, ruling out myocardial ischemia. Three (5.2%) non-q wave infarctions occured in this series, twice caused b y a peripheral embolisation during the crossing of the lesion with the wire und once because of "no-reflow". In the latter case the occlusion balloon had to be deflated before the aspiration could be performed. In 80 of 92 as pirates (86.9%) macroscopic embolic debris was visible. The PercuSurge GuardWire(TM) Temporary Occlusion & Aspiration System is a s afe and effective device for the protect;on of distal embolisation during i nterventions in degenerated aorto-coronary saphenous vein grafts.