Prevention of distal embolization during coronary angioplasty in saphenousvein grafts and native vessels using porous filter protection

Background-Although distal embolization and the "no-reflow" phenomenon are well described in saphenous vein graft (SVG) interventions, the frequency, magnitude, and characterization of embolized debris have not been evaluated in routine coronary interventions. A unique embolus protection device desc ribed herein provides a means of containing and retrieving plaque material dislodged during percutaneous coronary interventions. This report details t he first clinical experience of the effectiveness and safety of an emboli p rotection system in 11 SVG lesions and 15 native coronary artery lesions. Methods and Results-The AngioGuard Emboli Capture Guidewire (Cordis) consis ts of a PTCA wire with an expandable filter at the distal tip. The porous m embrane permits normal distal blood flow, while trapping potential emboli b y filtration. After crossing the lesion, the filter is expanded, and routin e angioplasty is performed over the same wire. Emboli retrieval is achieved by collapsing the filter and retracting the emboli capture wire (ECW). In 26 patients, standard angioplasty was performed over the ECW; 20 of these 2 6 patients received a stent. Collected debris was sent for histopathologica l analysis. Plaque debris was retrieved after native coronary and SVG inter ventions in all cases. The ECW was positioned and retrieved without complic ations. No major adverse events occurred. Myocardial infarctions and no-ref low were not observed. Conclusions-The embolization of plaque fragments frequently occurs during c oronary and SVG intervention. Distal embolization leading to microvascular obstruction and no-reflow could be successfully minimized by using the ECW.