Klinische Erfahrungen mit dem PercuSurge GuardWireTM– ein neues System zur Vermeidung von peripheren Embolien bei Katheterinterventionen an degenerierten aorto-koronaren Venenbypässen

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Abstract
Summary Periperal embolisation is a typical complication of catheter interventions in degenerated aorto-coronary saphenous vein grafts. Alternative techniques, such as transluminal extraction catheter (TEC), directional coronary athrectomy (DCA) and eximer laser angioplasty (ELCA) were not able to reduce the risk of peripheral vessel occlusion or “no-reflow”.¶ For the protection from peripheral embolisation we used the PercuSurge GuardWireTM Temporary Occlusion & Aspiration System (PercuSurge Inc., Sunnyvale, USA) in 55 patients with 58 stenosis in degenerated saphenous vein grafts. The primary endpoint of this consecutive series was to access the efficacy of the system by postinterventional TIMI flow and determination of serial CK/CK-MB.¶ The intervention was primarily successful in 55 of 58 cases (94.8%), with a reduction in stenosis from 87.6% (range 75–100%) to 4.5% (range 0–40%). TIMI flow improved from a mean of 2.1±1.4 to 2.9±0.4 after intervention. CK/CK-MB levels were 24/5, 27/7 and 26/6U/l (mean values) before, 8 hours, 16 hours and 24 hours after intervention, ruling out myocardial ischemia. Three (5.2%) non-q wave infarctions occured in this series, twice caused by a peripheral embolisation during the crossing of the lesion with the wire und once because of “no-reflow”. In the latter case the occlusion balloon had to be deflated before the aspiration could be performed. In 80 of 92 aspirates (86.9%) macroscopic embolic debris was visible. The PercuSurge GuardWireTM Temporary Occlusion & Aspiration System is a safe and effective device for the protection of distal embolisation during interventions in degenerated aorto-coronary saphenous vein grafts.

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