Retrieval and Analysis of Particulate Debris After Saphenous Vein Graft Intervention
Retrieval and Analysis of Particulate Debris After Saphenous Vein Graft Intervention Feature: Retrieval and Analysis of Particulate Debris After Saphenous Vein Graft Intervention - *John G. Webb, MD, *Ronald G. Carere, MD, **Renu Virmani, MD, ?Donald Baim, MD, ??Paul S. Teirstein, MD, §Patrick Whitlow, MD, §§Colleen McQueen, RN, **Frank D. Kolodgie, PhD, *Elizabeth Buller, RN, *Arthur Dodek, MD, ?G.B. John Mancini, MD, ??Stephen Oesterle, MD ABSTRACT: Objectives. Particulate matter is ...
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Significant Atheromatous Debris Following Uncomplicated Vein Graft Direct Stenting: Evidence Supporting Routine Use of Distal Protection Devices
We present the case of an angiographically uncomplicated direct stent vein graft intervention in which the Percusurge embolization containment device was used. We performed histological examination of the resulting debris and observed massive particulate atheromatous material. This case illustrates the severity of distal embolization that can go clinically unnoticed after direct stenting and also supports the routine use of distal protection devices for vein graft intervention.
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Export Aspiration Catheter-Enhanced FilterWire? Delivery: An Innovative Strategy for Treatment of Saphenous Vein Graft Disease
ABSTRACT: We report a series of 4 cases of percutaneous saphenous vein graft intervention on thrombus-containing occlusive lesions. After passing a 0.014-inch flexible coronary wire, primary thrombosuction was performed using an Export aspiration catheter (EAC). After removing the premounted delivery sheath, a 300-cm long FilterWire EZ was loaded into the aspiration lumen of the EAC. The EAC-FilterWire assembly was then advanced across the lesion; the filter sac was deployed after withdrawing the EAC. The coronary wire was removed, and angioplasty and stenting were performed in the usual manner over the FilterWire. Filter no-reflow developed in 2 cases, which was promptly reversed by repeated manual thrombosuction using the EAC. Finally, normal coronary blood flow was restored after filter retrieval. Visible thrombi or debris were detectable in 2 patients. This interventional strategy increases the efficiency of FilterWire delivery and also gives both active and passive embolic protection without causing any adverse clinical events. It may play a positive role in saphenous vein graft intervention and primary angioplasty in the future.
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Intragraft Nicardipine Prophylaxis to Prevent No-reflow in Triple-vessel Saphenous Vein Graft Intervention
ABSTRACT: Saphenous vein graft angioplasty and stenting has been associated with a relatively high risk of no-reflow and myocardial necrosis. The injectable dihydropyridine calcium channel blocker, nicardipine, is a highly potent arteriolar vasodilator, could be valuable as a prophylactic treatment to prevent no-reflow during SVG interventions. We examined the use of prophylactic, intracoronary (intra-graft) nicardipine, without distal protection, as a means to prevent no-reflow and myocardial necrosis in two consecutive patients undergoing 3-vessel, saphenous vein graft intervention. Following IC nicardipine injection, six stents were placed via direct stenting in the six degenerated SVGs. The average graft age was 13.5 years. Clinical, electrocardiographic, enzymatic (CPK and CPK-MB, troponin) and quantitative coronary angiographic methods were used to assess the safety and efficacy of this treatment in these two high-risk cases. There were no clinical, enzymatic or electrocardiographic signs of ischemia or injury after the use of nicardipine IC injection combined with direct stenting in these cases. Angiograph-ically, TIMI flow was 2.33 ± 0.52 prior to intervention, and improved to 3.0 ± 0.0 after intervention. The mean (TIMI) myocardial blush scores from the 6 SVG distributions improved from 1.82 ± 0.41 prior to intervention, to 2.67 ± 0.52 after intervention. The CPK peaks were 79 IU and 105 IU, respectively, in the two cases (upper limit normal = 190 IU). In summary, the dihydropyridine calcium channel blocker, nicardipine, may provide effective prophylaxis for no-reflow and myocardial necrosis, without the routine use of distal embolic protection devices, in SVG stent interventions. A larger prospective study is warranted to expand upon this preliminary observation.
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The Evolving Role of Glycoprotein (GP) IIb/IIIa Receptor Blockade During Percutaneous Coronary Intervention of Saphenous Vein Bypass Grafts
GP receptor blockade trials during SVGB intervention. B. Delayed SVBG intervention after pretreatment with a GP IIb/IIIa receptor blocker. D. Distal protection devices and GP IIb/IIIa receptor blockade.
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Drug-Eluting Stents and Saphenous Vein Graft Intervention
Drug-Eluting Stents and Saphenous Vein Graft Intervention Commentary: Drug-Eluting Stents and Saphenous Vein Graft Intervention - Sam McClure, MBChB and John Webb, MD The sting in the tail of successful saphenous vein graft (SVG) intervention is the high rate of in-stent restenosis. Effect of direct stenting on clinical outcome in patients treated with percutaneous coronary intervention on saphenous vein graft. Histology after stenting of human saphenous vein bypass grafts: Observations ...
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Randomized Trial of a Distal Embolic Protection Device During Percutaneous Intervention of Saphenous Vein Aorto-Coronary Bypass Grafts
Randomized Trial of a Distal Embolic Protection Device During Percutaneous Intervention of Saphenous Vein Aorto-Coronary Bypass Grafts Feature: Randomized Trial of a Distal Embolic Protection Device During Percutaneous Intervention of Saphenous Vein Aorto-Coronary Bypass Grafts - Donald S. Baim, MD, Dennis Wahr, MD, Barry George, MD, Martin B. Leon, MD, Joel Greenberg, MD, Donald E. Cutlip, MD, Unsal Kaya, MS, Jeffrey J. Popma, MD, Kalon K.L. Ho, ,MD, MSc, Richard E. Kuntz, MD, MSc; on behalf...
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?Pharmacologic? Distal Protection Using Prophylactic, Intragraft Nicardipine to Prevent No-Reflow and Non-Q-Wave Myocardial Infarction during Elective Saphenous Vein Graft Intervention
ABSTRACT: Background. Coronary saphenous vein bypass graft (SVG) stenting has been associated with up to a 30% rate of no-reflow or myocardial infarction (MI) when performed without distal protection. Methods. We evaluated the technique using prophylactic ?pharmacologic? arteriolar vasodilatation with intracoronary nicardipine followed by immediate direct stenting for the treatment of degenerated coronary SVGs without mechanical distal protection. Data were collected from 83 consecutive elective SVG interventions in 68 patients. Quantitative coronary angiographic measurements were performed by the Borgess angiographic core lab. Electrocardiograms (ECGs), CPKs, and CPK-MBs were obtained preprocedure and at 12?18 hours after the intervention. Follow-up data at 30 days were obtained in 67/68 (98%) patients. Results. The average graft age was 11.9 ± 6.6 years with thrombus in 26/83 vessels (31%). The primary adverse endpoint of total CPK > 3x the upper limit of normal (ULN), or CPK-MB >3 times the ULN were seen in 1/68 (1.5%) and 3/68 (4.4%) patients, respectively. No-/slow-reflow was observed transiently in 2/83 SVG interventions (2.4%). Of the patients, 1/68 had persistent, minor ECG changes after stenting (1.4%). No patient had a Q-wave MI. In-hospital major adverse cardiac events (MACE) (death, MI, repeat TLR) were observed in only 3/68 patients (CPK-MB elevation). There were no additional MACE events (0/68) from hospital discharge to 30 days. Conclusions. (1) Prophylactic vasodilatation with intragraft nicardipine followed by direct stenting appears to be a safe and effective means of performing elective SVG revascularization; (2) this approach may provide a simple and time- and cost-effective alternative or adjunct to mechanical distal protection for elective SVG interventions. J INVASIVE CARDIOL 2007;19:58?62
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Soluble Mediators of Microvascular Dysfunction ? Identifying the Invisible Culprits?
- Pedro Martinezclark, MD and Joseph P. Carrozza Jr., MD Percutaneous intervention of saphenous vein grafts is associated with approximately 20% risk of major adverse cardiovascular events secondary to decreased antegrade flow or ? This effect was blocked by the serotonin inhibitor ketanserin.13 Taken together, these studies suggest a putative role for these vasoactive substances in the pathophysiology of no-...
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Clinical and Economic Outcomes of Embolic Complications and Strategies for Distal Embolic Protection during Percutaneous Coronary Intervention in Saphenous Vein Grafts
Background. Although distal embolic protection (DEP) is increasingly utilized in saphenous vein graft percutaneous coronary intervention (SVG PCI), the clinical and economic outcomes of different DEP strategies are unknown. Methods. We compared 3 DEP strategies (no DEP, routine DEP, selective DEP in high-risk cases) in 126 consecutive cases of SVG PCI performed without DEP in a single catheterization laboratory over a 4-year period. No SVG PCI was excluded. High risk was defined using 2 multivariate predictors of embolic complication previously validated by NCDR (graft age greater than or equal to 8 years and/or friable appearance with thrombus). Costs were determined by a ratio of cost-to-charges methodology and average cost of the two FDA-approved DEP devices ($1,350) with similar efficacy. Results. Without DEP, the incidence of embolic complications was 17% (22/126), resulting in major adverse coronary events (MACE) in 3.2% (4/126) of all cases: 2 deaths, 1 myocardial infarction, and 1 emergency coronary artery bypass. Embolic complications significantly increased both procedure costs by $2,725 (p < .001) and total hospital costs ~$2,800 (p < 0.05). Risk adjustment for selective DEP use correctly predicted 86% (19/22) of embolic complications, including all MACE, at an incremental cost of $684/patient for selective DEP versus $1,150/patient for routine DEP. Selective DEP would cost $43,127 per death prevented versus $72,461 using routine DEP during the index hospitalization. Conclusions. Embolic complications increase cost in excess of the cost of a DEP device. This risk adjustment model correctly predicted the majority of cases of embolic complication and all MACE, suggesting that selective DEP use may help reduce utilization of DEP by an almost 50% cost reduction compared to routine use.
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 Electrophysiologic Perspective on the BIPOLAR RF EPICARDIAL ABLATION Procedure for Atrial Fibrillation
Complimentary Accredited Breakfast Symposium
Click Here for More Info.
Location: The St. Regis San Francisco
125 3rd Street
San Francisco, CA 94103
3rd and Mission Streets
Gallery Ballroom, 2nd floor
This activity is supported by an educational grant from AtriCure, Inc.
This program is not part of the Heart Rhythm 2008 Official Scientific Sessions as planned by the Heart Rhythm Society Scientific Sessions Committee. This event is neither sponsored nor endorsed by the Heart Rhythm Society.
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 Newest Perspectives on Drug-Eluting Stents
Complimentary CME Accredited Dinner Meetings Click Here for More Info.
Miami, FL - Date: Friday, April 4, 2008 6:00pm EST -8:00 pm EST
Birmingham, AL - Date: Friday, May 9, 2008 6:00pm EST -8:00 pm EST
This activity is supported by an educational grant from Abbott Vascular.
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 CLINICAL EXPERIENCE WITH A NEW HYBRID CORONARY WIRE
On Demand Web Archive
Non-Accredited
This activity is supported by an educational grant from Terumo Medical Corporation.
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 Pharmacoinvasive Management of Acute Coronary Syndrome: Incorporating the 2007 ACC/AHA Guidelines
Complimentary Accredited CME Program
This activity is supported by an educational grant from Sanofi-Aventis.
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 Varicose Veins: Causes, Symptoms, Diagnosis and Treatment of Chronic Venous Insufficiency
A Complimentary Accredited ON-DEMAND Webcast
This activity is supported by an educational grant from Diomed, Inc.
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 Create a Successful Vena Cava Filter Practice
Accredited CD
This activity is supported by an educational grant from Cook Incorporated and has been designed for Interventional Cardiologists, Vascular Surgeons, Fellows and Interventional Cardiovascular Nurses and Technologists.
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Webcast and Web Archives |
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 Achieving Optimal Outcomes in Carotid Stenting: Lessons Learned from Recent Clinical Trials
Complimentary Accredited ON DEMAND Webcast
Topics
1. EVA-3S & Space-Bumps in the road
2. CAPTURE 3500-Lesion morphology & Predictors for Stroke
3. CAPTURE II vs. EXACT 1500-Does open or Closed Cell Stent design really matter?
This activity has been developed for Interventional Cardiologists, Vascular Surgeons, Interventional Radiologists, Neurologists, Interventional Nurses and Technologists with an interest in the diagnosis and treatment of peripheral artery disease. |
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 Anticoagulation Techniques for Peripheral Vascular Interventions
Complimentary Accredited ON DEMAND Webcast
This activity has been developed for Interventional Cardiologists, Vascular Surgeons, Interventional Radiologists, Podiatric Physicians, Endovascular Allied Professionals, Endocrinologists, Wound Care Specialists, Directors of the Wound Care Clinic, and Primary Care Physicians, Pharmacists, Nurses and Technologists.
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 New Treatment Strategies for the Endovascular Approach to Critical Limb Ischemia: ADVANCEMENTS IN LIMB SALVAGE MEDICINE
Complimentary Accredited ON DEMAND Webcast
This activity has been developed for Interventional Cardiologists, Vascular Surgeons, Interventional Radiologists, Podiatric Physicians, Endovascular Allied Professionals, Endocrinologists, Wound Care Specialists, Directors of the Wound Care Clinic, and Primary Care Physicians, Pharmacists, Nurses and Technologists.
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 Reducing the Incidence of CIN during Cardiac Catheterization and PCI
Complimentary Accredited ON DEMAND
Educational Web Archive
This activity has been developed for nurses and technologists. |
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March 2007 Supplement
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On-Demand Webcast
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Archived Webcast
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Release Date: December 8, 2006