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Case-Control Registry of Excimer Laser Coronary Angioplasty Versus Distal Protection Devices in Patients With Acute Coronary Syndromes due to Saphenous Vein Graft Disease

Published:September 03, 2013DOI:https://doi.org/10.1016/j.amjcard.2013.07.015
      Laser atherectomy might decrease procedural complications during percutaneous coronary intervention (PCI) of degenerated saphenous vein grafts (SVGs) in case of unstable or thrombotic lesions because of its ability to debulk and vaporize thrombus. We aimed at prospectively evaluating the safety and efficacy of excimer laser coronary angioplasty (ELCA) as a primary treatment strategy in consecutively unstable patients undergoing PCI of degenerated SVG lesions. Seventy-one consecutive patients with non–ST elevation acute coronary syndrome (mean age 69 ± 10 years, 66 men [89%]) undergoing PCI of degenerated SVG were enrolled in a prospective case-control registry, using 2 different distal protection devices (DPDs; FilterWire EZ [Boston Scientific, Natick, Massachusetts; n = 24] and SpiderRX [Ev3, Plymouth, Minnesota; n = 23]) or ELCA (n = 24). Primary end points of the study were incidence of angiographic microvascular obstruction (Thrombolysis In Myocardial Infarction flow grade of <3 or Thrombolysis In Myocardial Infraction flow grade of 3 with myocardial blush grade 1 to 2) and incidence of type IVa myocardial infarction. Angiographic microvascular obstruction incidence tended to be less in ELCA-treated patients compared with DPD-treated patients (3 [13%] vs 15 [32%], p = 0.09). Type IVa myocardial infarction incidence was more in DPD-treated patients compared with ELCA-treated patients (23 [49%] vs 5 [21%], p = 0.04). In conclusion, in patients with non–ST elevation acute coronary syndrome undergoing PCI of degenerated SVG, ELCA compared with DPD, is associated with a trend for better myocardial reperfusion and a lesser incidence of periprocedural necrosis. Controlled randomized trials are warranted to confirm these early observations.
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      References

        • Fitzgibbon G.M.
        • Kafka H.P.
        • Leach A.J.
        • Keon W.J.
        • Hooper G.D.
        • Burton J.R.
        Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years.
        J Am Coll Cardiol. 1996; 28: 616-626
        • Coolong A.
        • Baim D.S.
        • Kuntz R.E.
        • O'Malley A.J.
        • Marulkar S.
        • Cutlip D.E.
        • Popma J.J.
        • Mauri L.
        Saphenous vein graft stenting and major adverse cardiac events: a predictive model derived from a pooled analysis of 3958 patients.
        Circulation. 2008; 117: 790-797
        • Gaglia Jr., M.A.
        • Torguson R.
        • Xue Z.
        • Gonzalez M.A.
        • Ben-Dor I.
        • Suddath W.O.
        • Kent K.M.
        • Satler L.F.
        • Pichard A.D.
        • Waksman R.
        Outcomes of patients with acute myocardial infarction from a saphenous vein graft culprit undergoing percutaneous coronary intervention.
        Catheter Cardiovasc Interv. 2011; 78: 23-29
        • Keeley E.C.
        • Velez C.A.
        • O'Neill W.W.
        • Safian R.D.
        Long-term clinical outcome and predictors of major adverse cardiac events after percutaneous interventions on saphenous vein grafts.
        J Am Coll Cardiol. 2001; 38: 659-665
        • Stone G.W.
        • Rogers C.
        • Ramee S.
        • White C.
        • Kuntz R.E.
        • Popma J.J.
        • George J.
        • Almany S.
        • Bailey S.
        Distal filter protection during saphenous vein graft stenting: technical and clinical correlates of efficacy.
        J Am Coll Cardiol. 2002; 40: 1882-1888
        • Webb J.G.
        • Carere R.G.
        • Virmani R.
        • Baim D.
        • Teirstein P.S.
        • Whitlow P.
        • McQueen C.
        • Kolodgie F.D.
        • Buller E.
        • Dodek A.
        • Mancini G.B.
        • Oesterle S.
        Retrieval and analysis of particulate debris after saphenous vein graft intervention.
        J Am Coll Cardiol. 1999; 34: 468-475
        • Baim D.S.
        • Wahr D.
        • George B.
        • Leon M.B.
        • Greenberg J.
        • Cutlip D.E.
        • Kaya U.
        • Popma J.J.
        • Ho K.K.
        • Kuntz R.E.
        Randomized trial of a distal embolic protection device during percutaneous intervention of saphenous vein aorto-coronary bypass grafts.
        Circulation. 2002; 105: 1285-1290
        • Carter L.I.
        • Golzar J.A.
        • Cavendish J.J.
        • Dixon S.R.
        Embolic protection of saphenous vein graft percutaneous interventions.
        J Interv Cardiol. 2007; 20: 351-358
        • Halkin A.
        • Masud A.Z.
        • Rogers C.
        • Hermiller J.
        • Feldman R.
        • Hall P.
        • Haber R.H.
        • Cambier P.A.
        • Caputo R.P.
        • Turco M.
        • Kovach R.
        • Brodie B.
        • Herrmann H.C.
        • Kuntz R.E.
        • Popma J.J.
        • Ramee S.
        • Cox D.A.
        • Mehran R.
        • Stone G.W.
        Six-month outcomes after percutaneous intervention for lesions in aortocoronary saphenous vein grafts using distal protection devices: results from the FIRE trial.
        Am Heart J. 2006; 151: 915.e1-915.e7
        • Mauri L.
        • Cox D.
        • Hermiller J.
        • Massaro J.
        • Wahr J.
        • Tay S.W.
        • Jonas M.
        • Popma J.J.
        • Pavliska J.
        • Wahr D.
        • Rogers C.
        The PROXIMAL trial: proximal protection during saphenous vein graft intervention using the Proxis Embolic Protection System: a randomized, prospective, multicenter clinical trial.
        J Am Coll Cardiol. 2007; 50: 1442-1449
        • Choudhury R.P.
        • Porto I.
        • Banning A.P.
        Images in cardiovascular medicine. Debris trapped by a distal protection device may mimic no-reflow during percutaneous coronary intervention.
        Circulation. 2004; 109: 803-804
        • Porto I.
        • Choudhury R.P.
        • Pillay P.
        • Burzotta F.
        • Trani C.
        • Niccoli G.
        • Blackman D.J.
        • Channon K.M.
        • Banning A.P.
        Filter no reflow during percutaneous coronary interventions using the Filterwire distal protection device.
        Int J Cardiol. 2006; 109: 53-58
        • Stone G.W.
        • Rogers C.
        • Hermiller J.
        • Feldman R.
        • Hall P.
        • Haber R.
        • Masud A.
        • Cambier P.
        • Caputo R.P.
        • Turco M.
        • Kovach R.
        • Brodie B.
        • Herrmann H.C.
        • Kuntz R.E.
        • Popma J.J.
        • Ramee S.
        • Cox D.A.
        Randomized comparison of distal protection with a filter-based catheter and a balloon occlusion and aspiration system during percutaneous intervention of diseased saphenous vein aorto-coronary bypass grafts.
        Circulation. 2003; 108: 548-553
        • Mathew V.
        • Lennon R.J.
        • Rihal C.S.
        • Bresnahan J.F.
        • Holmes Jr., D.R.
        Applicability of distal protection for aortocoronary vein graft interventions in clinical practice.
        Catheter Cardiovasc Interv. 2004; 63: 148-151
        • Ebersole D.
        • Dahm J.B.
        • Das T.
        • Madyoon H.
        • Vora K.
        • Baker J.
        • Hilton D.
        • Alderman E.
        • Topaz O.
        Excimer laser revascularization of saphenous vein grafts in acute myocardial infarction.
        J Invasive Cardiol. 2004; 16: 177-180
        • Porto I.
        • Belloni F.
        • Niccoli G.
        • Larosa C.
        • Leone A.M.
        • Burzotta F.
        • Trani C.
        • De Maria G.L.
        • Hamilton-Craig C.
        • Crea F.
        Filter no-reflow during percutaneous coronary intervention of saphenous vein grafts: incidence, predictors and effect of the type of protection device.
        EuroIntervention. 2011; 7: 955-961
        • Wijns W.
        • Kolh P.
        • Danchin N.
        • Di Mario C.
        • Falk V.
        • Folliguet T.
        • Garg S.
        • Huber K.
        • James S.
        • Knuuti J.
        • Lopez-Sendon J.
        • Marco J.
        • Menicanti L.
        • Ostojic M.
        • Piepoli M.F.
        • Pirlet C.
        • Pomar J.L.
        • Reifart N.
        • Ribichini F.L.
        • Schalij M.J.
        • Sergeant P.
        • Serruys P.W.
        • Silber S.
        • Sousa Uva M.
        • Taggart D.
        Guidelines on myocardial revascularization.
        Eur Heart J. 2010; 31: 2501-2555
        • Bittl J.A.
        • Sanborn T.A.
        • Yardley D.E.
        • Tcheng J.E.
        • Isner J.M.
        • Chokshi S.K.
        • Strauss B.H.
        • Abela G.S.
        • Walter P.D.
        • Schmidhofer M.
        • The Percutaneous Excimer Laser Coronary Angioplasty
        Predictors of outcome of percutaneous excimer laser coronary angioplasty of saphenous vein bypass graft lesions. The Percutaneous Excimer Laser Coronary Angioplasty Registry.
        Am J Cardiol. 1994; 74: 144-148
        • Giugliano G.R.
        • Falcone M.W.
        • Mego D.
        • Ebersole D.
        • Jenkins S.
        • Das T.
        • Barker E.
        • Ruggio J.M.
        • Maini B.
        • Bailey S.R.
        A prospective multicenter registry of laser therapy for degenerated saphenous vein graft stenosis: the COronary graft Results following Atherectomy with Laser (CORAL) trial.
        Cardiovasc Revasc Med. 2012; 13: 84-89
        • Ambrosini V.
        • Cioppa A.
        • Salemme L.
        • Tesorio T.
        • Sorropago G.
        • Popusoi G.
        • Stabile E.
        • Medolla A.
        • Cangella F.
        • Agrusta M.
        • Picano E.
        • Rubino P.
        Excimer laser in acute myocardial infarction: single centre experience on 66 patients.
        Int J Cardiol. 2008; 127: 98-102
        • Niccoli G.
        • Giubilato S.
        • Conte M.
        • Belloni F.
        • Cosentino N.
        • Marino M.
        • Mongiardo R.
        • Crea F.
        Laser for complex coronary lesions: impact of excimer lasers and technical advancements.
        Int J Cardiol. 2011; 146: 296-299
        • Topaz O.
        • Laser
        Topol E.J. Textbook of Interventional Cardiology. 4th ed. W.B. Saunders, Philadelphia2002: 235-255
      1. The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. TIMI Study Group.
        N Engl J Med. 1985; 312: 932-936
        • Gibson C.M.
        • Cannon C.P.
        • Daley W.L.
        • Dodge Jr., J.T.
        • Alexander Jr., B.
        • Marble S.J.
        • McCabe C.H.
        • Raymond L.
        • Fortin T.
        • Poole W.K.
        • Braunwald E.
        TIMI frame count: a quantitative method of assessing coronary artery flow.
        Circulation. 1996; 93: 879-888
        • van 't Hof A.W.
        • Liem A.
        • Suryapranata H.
        • Hoorntje J.C.
        • de Boer M.J.
        • Zijlstra F.
        Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction: myocardial blush grade. Zwolle Myocardial Infarction Study Group.
        Circulation. 1998; 97: 2302-2306
        • Gibson C.M.
        • de Lemos J.A.
        • Murphy S.A.
        • Marble S.J.
        • McCabe C.H.
        • Cannon C.P.
        • Antman E.M.
        • Braunwald E.
        Combination therapy with abciximab reduces angiographically evident thrombus in acute myocardial infarction: a TIMI 14 substudy.
        Circulation. 2001; 103: 2550-2554
        • Gibson C.M.
        • Murphy S.A.
        • Morrow D.A.
        • Aroesty J.M.
        • Gibbons R.J.
        • Gourlay S.G.
        • Barron H.V.
        • Giugliano R.P.
        • Antman E.M.
        • Braunwald E.
        Angiographic perfusion score: an angiographic variable that integrates both epicardial and tissue level perfusion before and after facilitated percutaneous coronary intervention in acute myocardial infarction.
        Am Heart J. 2004; 148: 336-340
        • Quan V.H.
        • Huynh R.
        • Seifert P.A.
        • Kuchela A.
        • Chen W.H.
        • Sutsch G.
        • Eisenhauer A.C.
        • Rogers C.
        Morphometric analysis of particulate debris extracted by four different embolic protection devices from coronary arteries, aortocoronary saphenous vein conduits, and carotid arteries.
        Am J Cardiol. 2005; 95: 1415-1419
        • Haase K.K.
        • Rose C.
        • Duda S.
        • Baumbach A.
        • Oberhoff M.
        • Anthanasiadis A.
        • Karsch K.R.
        Perspectives of coronary excimer laser angioplasty: multiplexing, saline flushing, and acoustic ablation control.
        Lasers Surg Med. 1997; 21: 72-78
        • Wolfe M.W.
        • Roubin G.S.
        • Schweiger M.
        • Isner J.M.
        • Ferguson J.J.
        • Cannon A.D.
        • Cleman M.
        • Cabin H.
        • Leya F.
        • Bonan R.
        • on behalf of the Heparin Registry Investigators
        Length of hospital stay and complications after percutaneous transluminal coronary angioplasty. Clinical and procedural predictors. Heparin Registry Investigators.
        Circulation. 1995; 92: 311-319
        • Holmes Jr., D.R.
        • Topol E.J.
        • Califf R.M.
        • Berdan L.G.
        • Leya F.
        • Berger P.B.
        • Whitlow P.L.
        • Safian R.D.
        • Adelman A.G.
        • Kellett Jr., M.A.
        • the CAVEAT-II Investigators
        A multicenter, randomized trial of coronary angioplasty versus directional atherectomy for patients with saphenous vein bypass graft lesions. CAVEAT-II Investigators.
        Circulation. 1995; 91: 1966-1974
        • Topaz O.
        • Minisi A.J.
        • Bernardo N.L.
        • McPherson R.A.
        • Martin E.
        • Carr S.L.
        • Carr Jr., M.E.
        Alterations of platelet aggregation kinetics with ultraviolet laser emission: the “stunned platelet” phenomenon.
        Thromb Haemost. 2001; 86: 1087-1093