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Filter no reflow during percutaneous coronary interventions using the Filterwire distal protection device
- Source :
- International Journal of Cardiology. 109:53-58
- Publication Year :
- 2006
- Publisher :
- Elsevier BV, 2006.
-
Abstract
- Background Distal protection devices are increasingly used to prevent embolization during percutaneous coronary interventions (PCI) in saphenous vein grafts (SVG) and native coronary arteries (NV). During interventions with the Filterwire device we have observed reduced flow that is reversible following removal of the filter (filter no reflow, FNR), which might be erroneously interpreted as true no reflow and might be associated with reduced capture efficiency of the basket. Methods We analyzed the incidence of FNR in 58 patients (60 lesions) at high risk of embolization undergoing PCI of either a SVG or a NV using the Filterwire (Boston Scientific, Natick, MA). Qualitative and quantitative angiographic analysis was performed, and the volume of collected debris was estimated using a photographic technique. Results In our population, about 1/3 of the cases showed FNR, which was associated with angiographically visible filling defects within the basket, indicating macroembolism. However some patients (especially those undergoing vein graft interventions) showed filling defects without FNR, and some others FNR without filling defects. Thus we tried to understand the predictors of FNR: FNR was associated with higher amount of collected debris (36.97±42.98 mm 3 vs. 11.31±18.47 mm 3 , p =0.005), was neither prevented by abciximab, nor predicted by high thrombotic burden, increasing stent volume or need for predilatation. When patient with and without angiographically evident macroembolisation were separately analyzed, a linear correlation of FNR with the quantity of debris was only apparent in the macroembolization group. Conclusions Interventionalists should be aware of the "Filter No Reflow", a common but reversible angiographic complication when the Filterwire device is used. Reduced flow seen during these procedures should be treated conservatively. Mechanical obstruction of the filter, but also other mechanisms (pharmacologically active debris? platelet aggregates?) play a role in this phenomenon.
- Subjects :
- Male
medicine.medical_specialty
Stenting
Percutaneous
Abciximab
medicine.medical_treatment
Embolism
Population
Coronary Disease
Constriction, Pathologic
No-reflow
Distal protection
Coronary Angiography
Immunoglobulin Fab Fragments
Angioplasty
Internal medicine
medicine
Humans
Saphenous Vein
Embolization
Angioplasty, Balloon, Coronary
education
Aged
Retrospective Studies
education.field_of_study
business.industry
Microcirculation
Antibodies, Monoclonal
Stent
Equipment Design
Middle Aged
Coronary arteries
medicine.anatomical_structure
Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE
Conventional PCI
Cardiology
Female
Radiology
Cardiology and Cardiovascular Medicine
business
Filtration
Platelet Aggregation Inhibitors
medicine.drug
Subjects
Details
- ISSN :
- 01675273
- Volume :
- 109
- Database :
- OpenAIRE
- Journal :
- International Journal of Cardiology
- Accession number :
- edsair.doi.dedup.....d0f0745ccc5738ac5c146d3a9555e625