Abstract
The clinical benefit of percutaneous intervention (PCI) depends on both angiographic success at the site of intervention as well as the restoration of adequate microvascular perfusion. Saphenous vein graft intervention is commonly associated with evidence of distal plaque embolization, which is correlated with worse clinical outcomes. Despite successful epicardial intervention in the acute MI patient treated with primary PCI, distal tissue perfusion may still be absent in up to 25% of cases [1-3]. Multiple devices and pharmacologic regimens have been developed and refined in an attempt to protect the microvascular circulation during both saphenous vein graft intervention and primary PCI in the acute MI setting. We will review the evidence for various techniques for embolic protection of the distal myocardium during saphenous vein graft PCI and primary PCI in the native vessel.
Highlights
The most frequent cause of ischemic heart disease is coronary atherosclerosis, which manifests in the acute presentation as plaque rupture with superimposed thrombus
The thrombi in acute coronary syndrome (ACS) and ST-segment elevation myocardial infarction (STEMI) are characterized by densely packed fibrin; in STEMI, the majority of the occlusive thrombus is made up of a loose network of fibrin and red cells, with a platelet component observed in the setting of sudden plaque rupture
The pivotal trial demonstrating the efficacy of embolic protection was the Saphenous vein graft Angioplasty Free of Emboli Randomized (SAFER) trial, which used a distal occlusion balloon and a separate aspiration catheter to retrieve debris liberated during percutaneous intervention (PCI)[18]
Summary
The most frequent cause of ischemic heart disease is coronary atherosclerosis, which manifests in the acute presentation as plaque rupture with superimposed thrombus. Trials of myocardial protection with Embolic Protection Devices (EPD) were originally used in the setting of saphenous vein graft (SVG) PCI (Table 1). Interceptor Plus embolic protection device shown to be non-inferior to approved Guardwire and FilterWire in percutaneous intervention of SVG.
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