ABSTRACT
Distal embolization is known to be an awful complication of vein graft intervention, especially so in old friable and degenerated vein grafts. Distal protection offers an attractive option to prevent embolization, and hence preserve the myocardium. Fifty- three patients [with chronic stable angina, unstable angina, or myocardial infarction [MI] with the cardiac enzymes back to normal] were randomized to two treatment modalities. Thirty-one patients were randomized to conventional angioplasty and/or stenting of vein grafts, as opposed to 22 patients who were randomized to distal protection utilizing the Guard Wire treatment. Major Adverse Cardiac Events [MACE] during index hospitalization and at thirty days were recorded for both groups. There was a 19.4% absolute [100% relative] reduction in the Major Adverse Cardiac Events [MACE] during index hospitalization [19.4% of the patients in the control group versus zero percent of the patients in the guard wire group, P= 0.032]. Major Adverse Cardiac Events [MACE] during the first 30 days following the index procedure were seen in 25.8% [n=8] of the patients in the control group, as opposed to zero percent of the patients in the control group [P= 0.009]. The results of the current study suggest that distal protection might be superior to the current conventional PTCA and/or stenting techniques when percutaneous treatment of saphenous vein grafts is to be attempted. Distal protection needs to be the "standard" procedure during SVG interventions, especially in light of the accumulating evidence of its superiority over stand-alone PTCA and stenting