Distal protection devices

Introduction

The use of Saphenous vein grafts (SVGs) in coronary bypass grafting is a widespread modality of coronary revascularization, however these grafts are often prone to both degeneration and occlusion due to accelerated SVG neointimal hyperplasia and accelerated atherosclerosis causing poor long-term patency and graft failure. The manipulation of atherosclerotic lesions with wires, balloons and stents is associated with dislodging and embolising plaque debris. Whether this debris causes clinical manifestations depends upon the amount of debris, the type and size of the particles, and the sensitivity of the perfused organ to reduced perfusion. The development of devices to prevent distal embolisation has raised awareness of this event and created a new tool for the coronary and peripheral interventionalist.

Distal embolisation occurs commonly. The procedural success of percutaneous coronary intervention (PCI) and the subsequent clinical outcome is markedly reduced in patients who sustain distal embolisation during intervention. Such embolisation is recognised in up to 15 % of patients with acute myocardial infarction (AMI) undergoing PCI, and angiographic indicators of embolisation are highly predictive of clinical and functional outcome 1